Healthcare Provider Details

I. General information

NPI: 1841106788
Provider Name (Legal Business Name): INTEGRA NEURO PAIN INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 VINELAND RD STE 114
ORLANDO FL
32819-7855
US

IV. Provider business mailing address

8297 CHAMPIONS GATE BLVD STE 463
CHAMPIONS GATE FL
33896-8387
US

V. Phone/Fax

Practice location:
  • Phone: 863-547-0788
  • Fax: 863-547-0789
Mailing address:
  • Phone: 863-547-0788
  • Fax: 863-547-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD MASOOM QURESHI
Title or Position: PHYSICIAN
Credential:
Phone: 863-547-0788