Provider Demographics
NPI:1962664672
Name:BIANCHI, SHANNON L (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:BIANCHI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760-0260
Mailing Address - Country:US
Mailing Address - Phone:808-346-1854
Mailing Address - Fax:
Practice Address - Street 1:82 PUUHONU PL STE 100
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-969-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMD-18825207LP2900X
HIMD-18825207L00000X
NY281550-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology