Healthcare Provider Details

I. General information

NPI: 1528535127
Provider Name (Legal Business Name): CENTER FOR PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DRIVE SUITE C
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

4960 SW 72ND AVE STE 405
MIAMI FL
33155-5506
US

V. Phone/Fax

Practice location:
  • Phone: 301-620-0012
  • Fax: 301-620-9687
Mailing address:
  • Phone: 469-458-9222
  • Fax: 540-918-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: SHANEKA TINCH
Title or Position: RCM MANAGER
Credential:
Phone: 469-458-9222