MEDICARE: TAVISH LEE DEMAYO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	18229	HI

General Provider Information

NPI Number	:	1053277749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAVISH LEE DEMAYO

Provider Business Mailing Address
First Line	:	75-5783 KAWENA ST
Second Line	:
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-2067
Country	:	US
Telephone Number	:	928-606-5435
Fax Number	:

Provider Business Practice Location Address
First Line	:	75-5783 KAWENA ST
Second Line	:
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-2067
Country	:	US
Telephone Number	:	928-606-5435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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Directions to “ TAVISH LEE DEMAYO ” Practice Location

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