Healthcare Provider Details

I. General information

NPI: 1891430336
Provider Name (Legal Business Name): MIAMI DERMATOLOGY AND MOHS SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BISCAYNE BLVD STE 900
MIAMI FL
33137-3232
US

IV. Provider business mailing address

4770 BISCAYNE BLVD STE 900
MIAMI FL
33137-3232
US

V. Phone/Fax

Practice location:
  • Phone: 305-404-3376
  • Fax: 305-404-6367
Mailing address:
  • Phone: 305-404-3376
  • Fax: 305-404-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MIESHA MERATI
Title or Position: OWNER
Credential: DO
Phone: 305-404-3376