Healthcare Provider Details

I. General information

NPI: 1386050854
Provider Name (Legal Business Name): REJUVEFACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2014
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 CLARK RD
SARASOTA FL
34233-3251
US

IV. Provider business mailing address

4901 CLARK RD
SARASOTA FL
34233-3251
US

V. Phone/Fax

Practice location:
  • Phone: 941-735-7532
  • Fax:
Mailing address:
  • Phone: 941-404-5438
  • Fax: 941-953-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK A CHECCONE
Title or Position: FACIAL PLASTIC SURGEON
Credential: MD
Phone: 941-735-7532