Healthcare Provider Details

I. General information

NPI: 1497359426
Provider Name (Legal Business Name): DERMATOLOGY CENTER OF THE PALM BEACHES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 S JOG RD
LAKE WORTH FL
33467-6511
US

IV. Provider business mailing address

5808 S JOG RD
LAKE WORTH FL
33467-6511
US

V. Phone/Fax

Practice location:
  • Phone: 561-968-7546
  • Fax: 561-968-1143
Mailing address:
  • Phone: 561-968-7546
  • Fax: 561-968-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBIN SHECTER
Title or Position: PRESIDENT
Credential: DO
Phone: 561-968-7546