Healthcare Provider Details

I. General information

NPI: 1477337988
Provider Name (Legal Business Name): RISING SUN DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 STATE ROAD 207
ST AUGUSTINE FL
32084-5938
US

IV. Provider business mailing address

665 STATE ROAD 207 STE 108
ST AUGUSTINE FL
32084-5939
US

V. Phone/Fax

Practice location:
  • Phone: 904-325-6165
  • Fax: 904-944-3044
Mailing address:
  • Phone: 904-325-6165
  • Fax: 904-944-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMI KAMEEL SAIKALY
Title or Position: DERMATOLOGIST/MANAGER
Credential: MD
Phone: 904-377-3471