MEDICARE: ORLANDO PAIN MANAGEMENT CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207QA0401X	Addiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1659214625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO PAIN MANAGEMENT CENTER LLC

Provider Business Mailing Address
First Line	:	5425 S SEMORAN BLVD STE 11
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-1777
Country	:	US
Telephone Number	:	407-658-4616
Fax Number	:	407-658-4617

Provider Business Practice Location Address
First Line	:	5425 S SEMORAN BLVD STE 11
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-1777
Country	:	US
Telephone Number	:	407-658-4616
Fax Number	:	407-658-4617

Authorized Official
Title or Position	:	CREDENTIALING AND CONTRACTING SPEC
Name	:	PHAEDRA LUND SHUDRA
Credential	:
Telephone Number	:	813-785-4861

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/16/2026

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Directions to “ORLANDO PAIN MANAGEMENT CENTER LLC ” Practice Location

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