Provider Demographics
NPI:1053337469
Name:CASTANERA, SHAYNE MARK (MD)
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:MARK
Last Name:CASTANERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5008
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-9008
Mailing Address - Country:US
Mailing Address - Phone:808-254-4670
Mailing Address - Fax:808-254-4670
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-486-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07052002Medicaid
HIH0091655OtherHMSA PROVIDER NUMBER
HI07052002Medicaid
HIH0091655OtherHMSA PROVIDER NUMBER