Healthcare Provider Details

I. General information

NPI: 1558315234
Provider Name (Legal Business Name): SAND LAKE DERMATOLOGY CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 W SAND LAKE RD SUITE 200
ORLANDO FL
32819-5538
US

IV. Provider business mailing address

7335 W SAND LAKE RD SUITE 200
ORLANDO FL
32819-5538
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-8553
  • Fax: 407-351-8412
Mailing address:
  • Phone: 407-352-8553
  • Fax: 407-351-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0050669
License Number StateFL

VIII. Authorized Official

Name: DR. ALLISON KAY ARTHUR
Title or Position: OWNER
Credential: M.D.
Phone: 407-352-8553