Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Interventional Spine and Pain Institute LLC

Organization Anesthesiology Physician · NPI 1093695504

Interventional Spine and Pain Institute LLC is an Anesthesiology Physician in Melbourne, Florida. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
6
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

6559 N Wickham Rd
Melbourne, FL 32940-2052
Phone: (772) 360-1997
Fax: (772) 492-3541
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Interventional Pain Medicine Physician (primary) Taxonomy 208VP0014X
Anesthesiology Physician Taxonomy 207L00000X
Pain Medicine (Anesthesiology) Physician Taxonomy 207LP2900X
Hospice and Palliative Medicine (Internal Medicine) Physician Taxonomy 207RH0002X
Physical Medicine & Rehabilitation Physician Taxonomy 208100000X
Pain Medicine Physician Taxonomy 208VP0000X

Record details

NPI number1093695504
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Phaedra Shudra — Credentialing And Contracting Speci · (813) 785-4861
NPI enumeratedSeptember 4, 2025
Last updated in NPPESSeptember 26, 2025
Certification dateSeptember 26, 2025
Mailing address777 37th St Ste C101, Vero Beach, FL 32960-7301

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