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General NPI Number Information
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NPI Number | 1346838984
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Entity Type | Organization
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Legal Business Name | SPINASTHESIA PLLC
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 3009 E RENNER RD STE 100
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City | RICHARDSON
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State | TX
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Zip | 75082-3572
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Country | US
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Telephone | 469-589-1871
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 E RENNER RD STE 100
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City | RICHARDSON
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State | TX
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Zip | 75082-3572
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Country | US
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Telephone |
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Fax | 469-676-4894
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ALAN SHEYDWASSER
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Credential | MD
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Telephone | 570-406-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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