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General NPI Number Information
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NPI Number | 1881754224
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Entity Type | Organization
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Legal Business Name | UNIQUE DERMATOLOGY & WELLNESS CENTER PA
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 4325 LYNX PAW TRL
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City | VALRICO
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State | FL
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Zip | 33594-7426
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Country | US
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Telephone | 813-684-9600
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Fax | 813-662-9777
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Provider Business Mailing Address
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Address Line | 4325 LYNX PAW TRL
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City | VALRICO
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State | FL
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Zip | 33594-7426
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Country | US
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Telephone | 813-684-9600
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Fax | 813-662-9777
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Authorized Official
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Title or Position | OWNER
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Name | DR. DYAN JENELLE HARVEY-DENT
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Credential | D.O.
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Telephone | 813-684-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OS8642
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | OS8642
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License Number State | FL
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