Provider Demographics
NPI:1043925985
Name:XYTAKIS, STEFANIA ANN (HEALTH COACH, RBT)
Entity type:Individual
Prefix:MS
First Name:STEFANIA
Middle Name:ANN
Last Name:XYTAKIS
Suffix:
Gender:
Credentials:HEALTH COACH, RBT
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 2636
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-7636
Mailing Address - Country:US
Mailing Address - Phone:808-250-2587
Mailing Address - Fax:
Practice Address - Street 1:427 ALA MAKANI ST STE 200
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3571
Practice Address - Country:US
Practice Address - Phone:808-204-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIN1204704171400000X
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171400000XOther Service ProvidersHealth & Wellness Coach