DR. SHALLON TORE CRADDOCK M.D. M.P.H. NPI 1700088846

NPI Information

  • NPI: 1700088846
  • Provider Name: DR. SHALLON TORE CRADDOCK, M.D., M.P.H.
  • Classification: Pediatrics - 208000000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 199 ULULANI ST
    HILO, HI
    ZIP 96720
  • Phone: (808) 315-1886

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NPI Details

DR. Shallon Tore Craddock, M.D., M.P.H. is a pediatrics in Hilo, HI with 20 years of experience. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. DR. Shallon Tore Craddock, M.D., M.P.H. NPI is 1700088846. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF COLORADO SCHOOL OF MEDICINE, AURORA
Graduation Year:2006

The provider's business location address is:

199 ULULANI ST
HILO, HI
ZIP 96720-930
Phone: (808) 315-1886
Fax: (808) 935-9259

The NPI 1700088846 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/1/2007 and was last updated on 3/21/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics7298ALASKANo
2208000000XPediatrics17956HAWAIIYes
3208000000XPediatrics036172973ILLINOISNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11574708MEDICAIDALASKA
2100306322MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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