Provider Demographics
NPI:1225472061
Name:TERAMAE-PENGRA, SAMANTHA (MS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:TERAMAE-PENGRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 22ND AVE RM 127
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-4400
Mailing Address - Country:US
Mailing Address - Phone:808-305-9812
Mailing Address - Fax:
Practice Address - Street 1:475 22ND AVE RM 127
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4400
Practice Address - Country:US
Practice Address - Phone:808-305-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8130235Z00000X
HISP-1371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist