Healthcare Provider Details

I. General information

NPI: 1174899082
Provider Name (Legal Business Name): FLORIDA ADVANCED MEDICAL AND DERM AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2012
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 S JOG RD STE 1B
DELRAY BEACH FL
33446-3806
US

IV. Provider business mailing address

13660 S JOG RD STE 1B
DELRAY BEACH FL
33446-3806
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-6622
  • Fax: 561-499-6795
Mailing address:
  • Phone: 561-499-6622
  • Fax: 561-499-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANJAN PATEL
Title or Position: MANAGER
Credential: M.D.
Phone: 215-435-8011