# SPACE COAST SPINE AND PAIN INSTITUTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093388217
- **Authorized official:** SONYA WARNICK (ADMINISTRATOR)
- **Authorized official phone:** (321) 432-5480

## Contact information

- **Practice address:** 205 E NASA BLVD STE 200, MELBOURNE, FL 32901-1954
- **Practice address phone:** (321) 361-5619
- **Mailing address:** 285 LANSING ISLAND DR, INDIAN HARBOUR BEACH, FL 32937-5102
- **Mailing address phone:** (321) 361-5619

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 07/24/2021
- **Last updated:** 07/24/2021