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

Interventional Spine and Pain Institute LLC

Organization Anesthesiology Physician · NPI 1396526901

Interventional Spine and Pain Institute LLC is an Anesthesiology Physician in Palm Bay, Florida. Registered with an NPI since 2023.

In the registry since
2023
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

5200 Babcock St NE Ste 111
Palm Bay, FL 32905-4639
Phone: (772) 360-1997
Fax: (772) 492-3541
Show map & directions

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 number1396526901
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Phaedra Shudra — Credentialing And Contracting Speci · (813) 785-4861
NPI enumeratedOctober 10, 2023
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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