Healthcare Provider Details

I. General information

NPI: 1538270335
Provider Name (Legal Business Name): AQUA DERMATOLOGY OF FLORIDA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VILLAGE SQUARE XING STE 210
PALM BEACH GARDENS FL
33410-4550
US

IV. Provider business mailing address

PO BOX 748497
ATLANTA GA
30374-8497
US

V. Phone/Fax

Practice location:
  • Phone: 239-313-2515
  • Fax:
Mailing address:
  • Phone: 239-313-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: THEODORE SCHIFF
Title or Position: OWNER
Credential: M.D.
Phone: 239-313-2515