MEDICARE: AZUREE AESTHETICS & SKIN CARE SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1255287421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZUREE AESTHETICS & SKIN CARE SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	304 3RD ST SW STE 3
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3409
Country	:	US
Telephone Number	:	863-529-6899
Fax Number	:	863-225-1148

Provider Business Practice Location Address
First Line	:	304 3RD ST SW STE 3
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3409
Country	:	US
Telephone Number	:	863-529-6899
Fax Number	:	863-225-1148

Authorized Official
Title or Position	:	OWNER
Name	:	MELINDA RENE SHORT-RUSSELL
Credential	:	DNP, APRN, FNP-BC
Telephone Number	:	863-259-6807

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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