Healthcare Provider Details

I. General information

NPI: 1396906871
Provider Name (Legal Business Name): MARCELYN COLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 SHERIDAN ST STE C
HOLLYWOOD FL
33021-3559
US

IV. Provider business mailing address

4060 SHERIDAN ST STE C
HOLLYWOOD FL
33021-3559
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-7512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME152720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: