Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 171 | HI |
N | 175L00000X | Homeopath |
NPI | 1154509578 |
---|---|
Provider Name | Dr. Shanon Lee Sidell |
First Address | Waikoloa, HI 96738-3194 |
Second Address | Waikoloa, HI 96738-5584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2008 |
Last Update Date | 12/02/2014 |