Individual
DR. SHALLON TORE CRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Contact information
Practice address
199 ULULANI ST, HILO, HI 96720-2930
(808) 315-1886
(808) 935-9259
Mailing address
2250 KAUMANA DR, HILO, HI 96720-1316
(808) 315-1519
(808) 935-9259
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036172973
IL
208000000X
Pediatrics Physician
Primary
17956
HI
208000000X
Pediatrics Physician
7298
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100306322
—
WI
05
—
1574708
—
AK
Enumeration date
06/01/2007
Last updated
03/21/2025
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