MEDICARE: AQUA DERMATOLOGY OF FLORIDA, PA

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	207N00000X	Dermatology Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538270335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AQUA DERMATOLOGY OF FLORIDA, PA

Provider Business Mailing Address
First Line	:	PO BOX 748497
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8497
Country	:	US
Telephone Number	:	239-313-2515
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 VILLAGE SQUARE XING STE 210
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4550
Country	:	US
Telephone Number	:	239-313-2515
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THEODORE SCHIFF
Credential	:	M.D.
Telephone Number	:	239-313-2515

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/18/2025

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