MEDICARE: FLORIDA PAIN AND REHABILITATION ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1144818790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PAIN AND REHABILITATION ASSOCIATES INC

Provider Business Mailing Address
First Line	:	4960 SW 72ND AVE STE 405
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5506
Country	:	US
Telephone Number	:	469-458-9222
Fax Number	:	540-918-7202

Provider Business Practice Location Address
First Line	:	1031 SE 9TH PLACE
Second Line	:	SUITE 5
City	:	CAPE CORAL
State	:	FL
Zip	:	33990
Country	:	US
Telephone Number	:	239-333-1177
Fax Number	:	239-939-4733

Authorized Official
Title or Position	:	RCM MANAGER
Name	:	SHANEKA TINCH
Credential	:
Telephone Number	:	469-458-9222

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	12/08/2025

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