Organization
INTERVENTIONAL SPINE AND PAIN INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHAEDRA L SHUDRA (CREDENTIALING AND CONTRACTING SPECI)
(813) 785-4861
Entity
Organization
Contact information
Practice address
5200 BABCOCK ST NE STE 111, PALM BAY, FL 32905-4639
(772) 360-1997
(772) 492-3541
Mailing address
777 37TH ST STE C101, VERO BEACH, FL 32960-7301
(772) 360-1997
(772) 492-3541
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
10/10/2023
Last updated
09/26/2025
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