Provider Demographics
NPI:1538990080
Name:CABUDOL, SHELDON
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:
Last Name:CABUDOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 KILAUEA AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2990
Mailing Address - Country:US
Mailing Address - Phone:808-935-5255
Mailing Address - Fax:
Practice Address - Street 1:194 KILAUEA AVE APT 102
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2990
Practice Address - Country:US
Practice Address - Phone:808-935-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPTA-714225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant