MEDICARE: RENEW PAIN AND WELLNESS CENTER OF SOUTH FLORIDA INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
2	261QI0500X	Infusion Therapy Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QP3300X	Pain Clinic/Center
5	207LP2900X	Pain Medicine (Anesthesiology) Physician
6	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1417809880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW PAIN AND WELLNESS CENTER OF SOUTH FLORIDA INC

Provider Business Mailing Address
First Line	:	4614 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6502
Country	:	US
Telephone Number	:	954-256-9422
Fax Number	:	954-256-9423

Provider Business Practice Location Address
First Line	:	4614 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6502
Country	:	US
Telephone Number	:	954-256-9422
Fax Number	:	954-256-9423

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DAVIE SHATIL
Credential	:
Telephone Number	:	954-256-9422

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	06/15/2026

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