Provider Demographics
NPI:1447553722
Name:DORAN, SHANNYN H (MAT)
Entity type:Individual
Prefix:MS
First Name:SHANNYN
Middle Name:H
Last Name:DORAN
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 S KIHEI RD
Mailing Address - Street 2:208B
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7283
Mailing Address - Country:US
Mailing Address - Phone:808-870-1225
Mailing Address - Fax:
Practice Address - Street 1:2439 S KIHEI RD
Practice Address - Street 2:208B
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7283
Practice Address - Country:US
Practice Address - Phone:808-870-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7249172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist