Healthcare Provider Details

I. General information

NPI: 1831026004
Provider Name (Legal Business Name): BW DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 MEDICO LN STE 101
MELBOURNE FL
32940-8946
US

IV. Provider business mailing address

2339 MEDICO LN STE 101
MELBOURNE FL
32940-8946
US

V. Phone/Fax

Practice location:
  • Phone: 321-406-8615
  • Fax:
Mailing address:
  • Phone: 321-406-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREW KELSEY
Title or Position: CEO
Credential: MD
Phone: 321-406-8615