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General NPI Number Information
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NPI Number | 1689319865
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Entity Type | Organization
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Legal Business Name | STOP PAIN PA
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 13554 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3233
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Country | US
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Telephone | 917-913-5521
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Fax |
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Provider Business Mailing Address
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Address Line | 13554 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3233
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Country | US
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Telephone | 917-913-5521
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | UNA SIBIRCEVA
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Credential | MD
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Telephone | 917-913-5521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 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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