| NPI | 1134880487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHAEDRA L SHUDRA Credentialing & Contracting Spec 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 | 2022-01-07 |
| Last Update Date | 2025-09-26 |