1356424824 NPI number — SHERI L AZAMA OTR

Table of content: LIPISHA SUSHIL AGARWAL MBBS (NPI 1437771433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356424824 NPI number — SHERI L AZAMA OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZAMA
Provider First Name:
SHERI
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIEBERMAN
Provider Other First Name:
SHERI
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR, OTD, CHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356424824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 S BERETANIA ST STE 730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-1881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-593-2830
Provider Business Mailing Address Fax Number:
808-593-2840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 S BERETANIA ST STE 730
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-593-2830
Provider Business Practice Location Address Fax Number:
808-593-2840
Provider Enumeration Date:
10/20/2006

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: 225XH1200X , with the licence number:  OT440 , 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)

  • Identifier: 549074 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".