MEDICARE: MY SPA STUDIO LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1639013238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY SPA STUDIO LLC

Provider Business Mailing Address
First Line	:	2010 NW 150TH AVE STE 120
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2888
Country	:	US
Telephone Number	:	954-990-0335
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 NW 150TH AVE STE 120
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2888
Country	:	US
Telephone Number	:	954-990-0335
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SAM KHAN
Credential	:
Telephone Number	:	954-990-0335

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

Similar Medicare Providers

1477580165 — DR. ARTHUR GLICK APRN
Practice Location Address:

2010 NW 150TH AVE , STE 120
PEMBROKE PINES, FL
33028-2888

Practice Phone: 954-431-9838
Practice Fax: 954-241-6726

1609177781 — MRS. MICHELLE COTAYO-LINARES MSN, APRN, FNP-BC
Practice Location Address:

2010 NW 150TH AVE STE 100
PEMBROKE PINES, FL
33028-2888

Practice Phone: 954-447-5206
Practice Fax: 954-447-5259

1316352545 — BLUE WATER PAIN SOLUTIONS, PA
Practice Location Address:

2010 NW 150TH AVE STE 100
PEMBROKE PINES, FL
33028-2888

Practice Phone: 954-447-5206
Practice Fax: 954-447-5259

1992107999 — THERAPIES 4 KIDS, INC.
Practice Location Address:

2010 NW 150TH AVE STE 120
PEMBROKE PINES, FL
33028-2888

Practice Phone: 954-431-9838
Practice Fax: 954-241-6726

1093105199 — GABRIEL D OSORIO PA
Practice Location Address:

2010 NW 150TH AVE STE 100
PEMBROKE PINES, FL
33028-2888

Practice Phone: 954-447-5206
Practice Fax:

1407367303 — MR. SHANE MAURICE CARSWELL APRN/PSYCH
Practice Location Address:

2010 NW 150TH AVE STE 120
PEMBROKE PINES, FL
33028-2888

Practice Phone: 954-431-9838
Practice Fax: 954-241-6726

Directions to “MY SPA STUDIO LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.