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General NPI Number Information
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NPI Number | 1912158783
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Entity Type | Organization
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Legal Business Name | FLORIDA REGIONAL PAIN MANAGEMENT, PA
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 8259 BAYBERRY RD
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7432
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Country | US
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Telephone | 904-737-7246
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Fax | 904-737-2700
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Provider Business Mailing Address
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Address Line | 8259 BAYBERRY RD
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7432
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Country | US
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Telephone | 904-737-7246
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Fax | 904-737-2700
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHONITH MANOHAR
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Credential | MD
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Telephone | 904-737-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | ME66980
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License Number State | FL
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