Provider Demographics
NPI:1548374929
Name:SHARIPOVA, ELENA G (MD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:G
Last Name:SHARIPOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:SHARIPOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 860868
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-0868
Mailing Address - Country:US
Mailing Address - Phone:808-772-6453
Mailing Address - Fax:909-942-2526
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 704
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-772-6453
Practice Address - Fax:909-942-2526
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-126052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI580515Medicaid
AZ100028Medicare UPIN
HI101490Medicare ID - Type Unspecified
HI580515Medicaid