Interventional Spine and Pain Institute LLC
NPI 1134880487 · Interventional Pain Medicine Physician · Vero Beach, FL
Provider details
- NPI number
- 1134880487
- Entity type
- Organization
- Primary specialty
- Interventional Pain Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Phaedra Shudra, Credentialing & Contracting Spec(813) 785-4861
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Anesthesiology Physician207L00000X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
- Pain Medicine (Anesthesiology) Physician207LP2900X
Allopathic & Osteopathic Physicians
- Pain Medicine Physician208VP0000X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
3 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (2)
- 6559 N Wickham RdMelbourne, FL 32940-2052Phone: (772) 360-1997Fax: (772) 492-3541
- 5200 Babcock St Ne Ste 111Palm Bay, FL 32905-4639Phone: (772) 360-1997Fax: (772) 492-3541
Registry dates
- Enumerated
- 2022-01-07
- Last updated
- 2025-09-26
- Certified
- 2025-09-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.