Healthcare Provider Details

I. General information

NPI: 1891496725
Provider Name (Legal Business Name): SPINE SPECIALISTS OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 COMMODITY CIR STE 25
ORLANDO FL
32819-9066
US

IV. Provider business mailing address

30200 TELEGRAPH RD STE 456
BINGHAM FARMS MI
48025-4506
US

V. Phone/Fax

Practice location:
  • Phone: 407-487-8610
  • Fax: 407-487-8605
Mailing address:
  • Phone: 407-487-8610
  • Fax: 407-487-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENDA SELLNOW
Title or Position: ADMIN
Credential:
Phone: 321-236-8004