Healthcare Provider Details

I. General information

NPI: 1104759208
Provider Name (Legal Business Name): SHIVSPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD STE 400
STUART FL
34994-4512
US

IV. Provider business mailing address

591 EVERNIA ST APT 301
WEST PALM BEACH FL
33401-5777
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2400
  • Fax:
Mailing address:
  • Phone: 954-829-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIVAM UPADHYAYA
Title or Position: PRESIDENT
Credential: MD
Phone: 954-829-4330