Healthcare Provider Details

I. General information

NPI: 1568977973
Provider Name (Legal Business Name): PRC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HAND AVE STE A1
ORMOND BEACH FL
32174-1140
US

IV. Provider business mailing address

1671 N CLYDE MORRIS BLVD STE 100
DAYTONA BEACH FL
32117-5590
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-2977
  • Fax: 386-274-2997
Mailing address:
  • Phone: 386-274-2977
  • Fax: 386-274-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJAY BAKSHI
Title or Position: OWNER/CEO
Credential: MD
Phone: 386-274-2977