Healthcare Provider Details

I. General information

NPI: 1053299164
Provider Name (Legal Business Name): PELVIC SOLUTION INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 AVE PONCE DE LEON OFICINA 136-12
SAN JUAN PR
00726
US

IV. Provider business mailing address

PO BOX 6480
CAGUAS PR
00726-6480
US

V. Phone/Fax

Practice location:
  • Phone: 787-226-5425
  • Fax:
Mailing address:
  • Phone: 787-226-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAYAN KHORSANDI
Title or Position: PRESIDENT
Credential: MD
Phone: 787-226-5425