=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750254959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKINDULGENCE MEDSPA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2025
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 COLTSGATE RD STE 101
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28211-3573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-516-0024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8706 CASE RIDGE DR
-----------------------------------------------------
City | OAK RIDGE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27310-9690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-972-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. ROHIT ROY KAVURI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-972-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------