Basic Information
| Provider Information | |||||||||
| NPI: | 1962745075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEPPARD | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | NOEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FEDORKA | ||||||||
| OtherFirstName: | ALLISON | ||||||||
| OtherMiddleName: | NOEL | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | BCBA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1557 ULUHAO ST | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967344422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083860331 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2226 LILIHA ST STE 403 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968171605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086381882 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2013 | ||||||||
| LastUpdateDate: | 05/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BA297 | HI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.