Organization
SUNNYSIDE MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE SHANKS NP (OWNER)
(808) 825-0190
Entity
Organization
Contact information
Practice address
1005 KEOLU DR STE A, KAILUA, HI 96734-3873
(808) 727-1715
Mailing address
84-740 KILI DR, 427, WAIANAE, HI 96792-1509
(808) 825-0190
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/14/2017
Last updated
12/12/2019
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