Provider Demographics
NPI:1992743108
Name:TAKAMINE, SANDRA AKIKO (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:AKIKO
Last Name:TAKAMINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:HAKALAU
Mailing Address - State:HI
Mailing Address - Zip Code:96710-0326
Mailing Address - Country:US
Mailing Address - Phone:808-963-5462
Mailing Address - Fax:
Practice Address - Street 1:101 AUPUNI ST
Practice Address - Street 2:SUITE 118
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4246
Practice Address - Country:US
Practice Address - Phone:808-963-5462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-294103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist