Provider Demographics
NPI:1851130678
Name:NGATUVAI, SHANICE
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:
Last Name:NGATUVAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PAULOA PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8989
Mailing Address - Country:US
Mailing Address - Phone:808-385-5510
Mailing Address - Fax:
Practice Address - Street 1:112 PAULOA PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8989
Practice Address - Country:US
Practice Address - Phone:808-385-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI23-318196106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician