Provider Demographics
NPI:1386046910
Name:WANG, SYDNEY KAPUAMEALANI (MS)
Entity type:Individual
Prefix:MISS
First Name:SYDNEY
Middle Name:KAPUAMEALANI
Last Name:WANG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 AWAPUHI STREET
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5290
Mailing Address - Country:US
Mailing Address - Phone:808-365-8128
Mailing Address - Fax:808-961-6383
Practice Address - Street 1:2148 AWAPUHI STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5290
Practice Address - Country:US
Practice Address - Phone:808-365-8128
Practice Address - Fax:808-961-6383
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP1661235Z00000X, 235Z00000X
MA76993235Z00000X
COSLP.0002814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000133Medicaid