Healthcare Provider Details

I. General information

NPI: 1689319865
Provider Name (Legal Business Name): STOP PAIN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13554 ATLANTIC BLVD
JACKSONVILLE FL
32225-3233
US

IV. Provider business mailing address

13554 ATLANTIC BLVD
JACKSONVILLE FL
32225-3233
US

V. Phone/Fax

Practice location:
  • Phone: 917-913-5521
  • Fax:
Mailing address:
  • Phone: 917-913-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: UNA SIBIRCEVA
Title or Position: OWNER
Credential: MD
Phone: 917-913-5521