Healthcare Provider Details

I. General information

NPI: 1962664672
Provider Name (Legal Business Name): SHANNON L BIANCHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 PUUHONU PL STE 100
HILO HI
96720-2010
US

IV. Provider business mailing address

PO BOX 260
KURTISTOWN HI
96760-0260
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-9669
  • Fax:
Mailing address:
  • Phone: 808-346-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD-18825
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-18825
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: