1235421926 NPI number — MRS. ROBYN MAHANA SANDEFUR PSY D

Table of content: MRS. ROBYN MAHANA SANDEFUR PSY D (NPI 1235421926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235421926 NPI number — MRS. ROBYN MAHANA SANDEFUR PSY D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDEFUR
Provider First Name:
ROBYN
Provider Middle Name:
MAHANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PSY D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHANG
Provider Other First Name:
ROBYN
Provider Other Middle Name:
MAHANA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235421926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 KAMAKE'E STREET
Provider Second Line Business Mailing Address:
SUITE 409
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-729-7698
Provider Business Mailing Address Fax Number:
866-313-3630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 KAMAKEE STREET
Provider Second Line Business Practice Location Address:
SUITE 409
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-729-7698
Provider Business Practice Location Address Fax Number:
866-313-3630
Provider Enumeration Date:
05/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY-1255 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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