Basic Information
| Provider Information | |||||||||
| NPI: | 1033377833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHACKELFORD | ||||||||
| FirstName: | BRENNA | ||||||||
| MiddleName: | MAE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3350 LOWER HONOAPIILANI RD # 215-121 | ||||||||
| Address2: | |||||||||
| City: | LAHAINA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967618402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029374899 | ||||||||
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| Practice Location | |||||||||
| Address1: | 221 MAHALANI ST | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967932526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082422290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2008 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01067626A | IN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.