Healthcare Provider Details

I. General information

NPI: 1760276174
Provider Name (Legal Business Name): REJUVENATE HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANNON L BIANCHI
Title or Position: MANAGER, ANESTHESIOLOGIST EMPLOYEE
Credential: MD
Phone: 808-765-0378