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General NPI Number Information
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NPI Number | 1427841865
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Entity Type | Organization
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Legal Business Name | SKIN DERMATOLOGY AND COSMETIC SERVICES, P.A.
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 13798 SPEER ISLAND DR
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City | WINDERMERE
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State | FL
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Zip | 34786-7380
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Country | US
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Telephone | 386-256-1969
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Fax | 386-960-7863
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Provider Business Mailing Address
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Address Line | 865 SAXON BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8204
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Country | US
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Telephone | 386-256-1969
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Fax | 386-960-7863
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SHAWNA FRAME
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Credential |
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Telephone | 423-525-5993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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