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General NPI Number Information
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NPI Number | 1295278943
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Entity Type | Organization
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Legal Business Name | FLORIDA DERMATOLOGY PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 6559 N WICKHAM RD SUITE 105
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City | MELBOURNE
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State | FL
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Zip | 32940-2039
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Country | US
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Telephone | 321-345-0552
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 628721
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City | ORLANDO
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State | FL
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Zip | 32862-8721
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Country | US
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Telephone | 321-241-1160
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANITA SALUJA
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Credential | M.D.
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Telephone | 321-917-3067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME118444
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | M82777
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License Number State | FL
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