MEDICARE: PRC ASSOCIATES 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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1902118201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRC ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1671 N CLYDE MORRIS BLVD STE 100
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5590
Country	:	US
Telephone Number	:	386-274-2977
Fax Number	:	386-274-2997

Provider Business Practice Location Address
First Line	:	1165 DUNLAWTON AVE
Second Line	:	SUITE 101
City	:	PT. ORANGE
State	:	FL
Zip	:	32127
Country	:	US
Telephone Number	:	386-760-0815
Fax Number	:	386-767-7890

Authorized Official
Title or Position	:	OWNER
Name	:	SANJAY BAKSHI
Credential	:	MD
Telephone Number	:	386-274-2977

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	10/08/2025

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Directions to “PRC ASSOCIATES LLC ” Practice Location

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