MEDICARE: PALM BEACH PAIN MANAGEMENT SPECIALISTS INC

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	208VP0014X	Interventional Pain Medicine Physician
2	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1881453777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH PAIN MANAGEMENT SPECIALISTS INC

Provider Business Mailing Address
First Line	:	907 N FEDERAL HWY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-3224
Country	:	US
Telephone Number	:	561-292-3747
Fax Number	:	561-292-3730

Provider Business Practice Location Address
First Line	:	907 N FEDERAL HWY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-3224
Country	:	US
Telephone Number	:	561-292-3747
Fax Number	:	561-292-3730

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SHANNEN SEVERSEN
Credential	:
Telephone Number	:	561-292-3747

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	02/12/2026

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