Healthcare Provider Details

I. General information

NPI: 1053007898
Provider Name (Legal Business Name): CHOICE PAIN & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BIDDLE AVE STE 101
NEWARK DE
19702-3982
US

IV. Provider business mailing address

8843 GREENBELT RD STE 117
GREENBELT MD
20770-2451
US

V. Phone/Fax

Practice location:
  • Phone: 302-392-3380
  • Fax:
Mailing address:
  • Phone: 240-786-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRISTAN SHOCKLEY
Title or Position: CEO
Credential: MD
Phone: 224-347-4875