Provider Demographics
NPI:1457952137
Name:REMANI RAVI, ANEESH
Entity type:Individual
Prefix:
First Name:ANEESH
Middle Name:
Last Name:REMANI RAVI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1001 KEAUNUI DR UNIT 153
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6328
Mailing Address - Country:US
Mailing Address - Phone:219-299-0552
Mailing Address - Fax:
Practice Address - Street 1:91-1001 KEAUNUI DR UNIT 153
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6328
Practice Address - Country:US
Practice Address - Phone:219-299-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN3078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health