Healthcare Provider Details

I. General information

NPI: 1881453777
Provider Name (Legal Business Name): PALM BEACH PAIN MANAGEMENT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 06/06/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 N FEDERAL HWY
BOYNTON BEACH FL
33435-3224
US

IV. Provider business mailing address

907 N FEDERAL HWY
BOYNTON BEACH FL
33435-3224
US

V. Phone/Fax

Practice location:
  • Phone: 561-292-3747
  • Fax: 561-292-3730
Mailing address:
  • Phone: 561-292-3747
  • Fax: 561-292-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANNEN SEVERSEN
Title or Position: PRESIDENT
Credential:
Phone: 561-292-3747