=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598347726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA PAIN AND REHABILITATION ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2021
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1930 NE 47TH ST SUITE 300
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-493-5048
-----------------------------------------------------
Fax | 877-376-4036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4960 SW 72ND AVE STE 405
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-5506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-458-9222
-----------------------------------------------------
Fax | 540-918-7202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RCM MANAGER
-----------------------------------------------------
Name | SHANEKA TINCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-458-9222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------