Provider Demographics
NPI:1538451174
Name:SANDSTEDT, SHELAGH JANE (LMT, CLT)
Entity type:Individual
Prefix:
First Name:SHELAGH
Middle Name:JANE
Last Name:SANDSTEDT
Suffix:
Gender:F
Credentials:LMT, CLT
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 1663
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-1663
Mailing Address - Country:US
Mailing Address - Phone:808-344-2017
Mailing Address - Fax:
Practice Address - Street 1:310 OHUKAI RD STE 310
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7061
Practice Address - Country:US
Practice Address - Phone:808-344-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11571225700000X
HIMAT-11571225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist