Healthcare Provider Details

I. General information

NPI: 1902366008
Provider Name (Legal Business Name): MCKENNA BRYN ABERCROMBIE DEWEES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENNA ABERCROMBIE DO

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MEDICAL OAKS AVE STE 102
BRANDON FL
33511-5995
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 866-400-3376
  • Fax: 813-651-1401
Mailing address:
  • Phone: 866-400-3376
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: