Healthcare Provider Details

I. General information

NPI: 1508976010
Provider Name (Legal Business Name): DIVINE DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 9TH AVE N STE 100
ST PETERSBURG FL
33713-7147
US

IV. Provider business mailing address

2191 9TH AVE N STE 100
ST PETERSBURG FL
33713-7147
US

V. Phone/Fax

Practice location:
  • Phone: 727-528-0321
  • Fax: 727-498-8832
Mailing address:
  • Phone: 727-528-0321
  • Fax: 727-498-8832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME87149
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEHA CHANDAN
Title or Position: OWNER
Credential: MD
Phone: 727-528-0321