| NPI | 1093695504 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | PHAEDRA L SHUDRA Credentialing And Contracting Speci 813-785-4861 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine | 
| Additional Taxonomies | 207L00000X Anesthesiology | 
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine | |
| 207LP2900X Anesthesiology, Pain Medicine | |
| 208VP0000X | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2025-09-04 | 
| Last Update Date | 2025-09-26 |