Healthcare Provider Details

I. General information

NPI: 1538080684
Provider Name (Legal Business Name): DERMALIER CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 CLEAR VISTA ST
ORLANDO FL
32832-7151
US

IV. Provider business mailing address

10140 CLEAR VISTA ST STE 4
ORLANDO FL
32832-7151
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-7784
  • Fax:
Mailing address:
  • Phone: 407-900-7784
  • Fax: 407-340-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VANESSA C PEIXOTO
Title or Position: OWNER AND NP
Credential: NP
Phone: 407-900-7784