Basic Information
| Provider Information | |||||||||
| NPI: | 1134126014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REGENBAUM | ||||||||
| FirstName: | SHELDON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5644 WHIRLAWAY RD | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334187735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616264605 | ||||||||
| FaxNumber: | 5616264168 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 N DIXIE HWY | ||||||||
| Address2: | STE 103 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334012715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618338893 | ||||||||
| FaxNumber: | 5618338939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 07/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | ME0065837 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 374949500 | 05 | FL | MEDICAID |