Healthcare Provider Details

I. General information

NPI: 1144855172
Provider Name (Legal Business Name): YOUNG SKIN, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 S UNIVERSITY DR STE 102
DAVIE FL
33328-5316
US

IV. Provider business mailing address

11076 MERIDIAN DR N
PARKLAND FL
33076-4592
US

V. Phone/Fax

Practice location:
  • Phone: 954-242-4275
  • Fax: 954-530-5562
Mailing address:
  • Phone: 954-821-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LATANYA T. BENJAMIN
Title or Position: PRESIDENT
Credential: MD
Phone: 954-821-1331