Interventional Spine and Pain Institute LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

INTERVENTIONAL SPINE AND PAIN INSTITUTE LLC

Practice address

5200 Babcock St NE Ste 111
Palm Bay, FL 32905-4639

Phone

(772) 360-1997

Fax

(772) 492-3541

NPI assigned

Oct 10, 2023

Last updated

Sep 26, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Phaedra L Shudra

Title

Credentialing and Contracting Speci

Phone

(813) 785-4861

Specialties & licenses 6

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758844800000",
    "number": "1396526901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 37TH ST STE C101",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329607301",
            "telephone_number": "772-360-1997",
            "fax_number": "772-492-3541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 BABCOCK ST NE STE 111",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329054639",
            "telephone_number": "772-360-1997",
            "fax_number": "772-492-3541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL SPINE AND PAIN INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-10",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A",
        "authorized_official_last_name": "SHUDRA",
        "authorized_official_first_name": "PHAEDRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING AND CONTRACTING SPECI",
        "authorized_official_telephone_number": "813-785-4861"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohammad Idrees, M.D.
• III-D Therapy Services
• In Transition Transport, Inc.
• Inez Gwendolyn Freeman, Robert Lee Freeman (Inez Gwendolyn Freeman)
• Institute for Optimum Health
• Madison L Ireland
• Megan Nicole Irving, NP
• Ramon Isales, M.D.
• David Dominic Isnardi II, PMHNP
• Farhan Rashid Israr, D.O

• Interventional Pain Medicine Physician in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Interventional Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.