Active NPI
Bridget Diane Shelley
- Behavior Technician
- Kahuku, HI
National Provider Identifier
1669192878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-22-226614
- Practice address
- 56-592 Pualalea PL
Kahuku, HI 96731-2047 - Phone
- (808) 292-7968
- NPI assigned
- Aug 29, 2022
- Last updated
- Aug 31, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-22-226614 | AZ | Primary |
Addresses
Primary practice location
56-592 Pualalea PL
Kahuku, HI 96731-2047
Mailing address
55-607 Moana St
Laie, HI 96762-1237
Phone (480) 204-6831
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-22-226614 | AZ | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1669192878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55-607 MOANA ST",
"city": "LAIE",
"state": "HI",
"postal_code": "967621237",
"telephone_number": "480-204-6831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56-592 PUALALEA PL",
"city": "KAHUKU",
"state": "HI",
"postal_code": "967312047",
"telephone_number": "808-292-7968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELLEY",
"first_name": "BRIDGET",
"middle_name": "DIANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-29",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AZ",
"license": "RBT-22-226614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kahuku, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.