LEGENDS DERMATOLOGY, LLC (NPI# 1780081869) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780081869 |
| Entity Type | Organization |
| Organization Name | LEGENDS DERMATOLOGY, LLC |
| Practice Address |
1497 Legends Boulevard Davenport FL 33896 |
| Practice Telephone | 8637385487 |
| Mailing Telephone | 8637385487 |
| Mailing Fax Number | 8636197094 |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2019-09-26 |
| Authorized Official Name | IULIA FUNIERU (SOLE OWNER) |
| Authorized Official Telephone | 8637385487 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Street Address |
1497 LEGENDS BOULEVARD |
| City | DAVENPORT |
| State | FL |
| Zip Code | 33896 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780299446 | Credence Homes LLC | In Home Supportive Care | 887 Knightsbridge Circle, Davenport, FL 33896 | 2020-09-10 |
| 1528685468 | Melodee Casas Contreras | Pharmacist | 6075 Hwy 17-92 N, Davenport, FL 33896 | 2020-06-26 |
| 1285296350 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 6075 Hwy 17-92 North, Davenport-polk, FL 33896 | 2019-06-28 |
| 1124476064 | Parent Support, LLC | Community Based Residential Treatment Facility, Mental Illness | 146 Sunset View Dr., Davenport, FL 33896 | 2016-06-01 |
| 1891176160 | Annissa Michael | Dentist | 7551 Osceola Polk Line Road, Davenport, FL 33896 | 2015-06-12 |
| 1144661166 | Parent Support, LLC | Community Based Residential Treatment Facility, Mental Illness | 389 Sand Ridge Dr., Davenport, FL 33896 | 2013-07-08 |
| 1982984498 | Ruba Khandakji | Pharmacist | 1395 Tuscana Lane, Davenport, FL 33896 | 2011-08-29 |
| 1326358029 | Sabrina C Pardo | Dietitian, Registered | 2000 Victoria Park Dr., Apt. 2302, Davenport, FL 33896 | 2010-10-15 |
| 1649598491 | Functional Physical Therapy, LLC | Physical Therapist | 1310 Island Green St, Champions Gate, FL 33896 | 2010-05-04 |
| 1750544706 | Citrus Family Medical Center LLC | Clinic/Center | 1485 Legends Boulevard, Davenport, FL 33896 | 2008-07-09 |
| Find all providers in zip 33896 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134352677 | Caring Dermatology Center PC | Dermatology | 4624 Progress Dr, Suite D, Davenport, IA 52807-3490 | 2009-09-01 |
| 1609071364 | Jill L. Lightfoot | Dermatology | 2322 E Kimberly Rd Ste 100n, Davenport, IA 52807-7207 | 2007-06-20 |
| 1922047869 | Ravindrakumar Gangadhariah | Dermatology | 4624 Progress Drive Ste D, Davenport, IA 52807 | 2006-06-06 |
| 1144229279 | William Colantoni Jr. | Dermatology | 100 E Kimberly Rd, Suite 303, Davenport, IA 52806-5924 | 2005-07-20 |
| 1326176983 | Accredited Dermatology Associates, P.C. | Dermatology | 2322 E Kimberly Rd, Suite N100, Davenport, IA 52807-7205 | 2007-03-02 |
| 1790813368 | Robert F. Godwin | Dermatology | 2322 E Kimberly Rd, Suite N100, Davenport, IA 52807-7205 | 2007-03-02 |
| 1396803375 | John Allen Bovenmyer | Dermatology | 3319 Spring St, Suite 102, Davenport, IA 52807-2125 | 2006-12-04 |
| 1477621761 | Bovenmyer Dermatology PC | Dermatology | 3319 Spring St, Suite 102, Davenport, IA 52807-2125 | 2006-12-03 |
| 1942209077 | Wm Colantoni Jr Md PC | Dermatology | 100 E Kimberly Rd, Suite 303, Davenport, IA 52806-5924 | 2005-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962002154 | Precision Skin LLC | Dermatology | 3501 S University Dr Ste 5, Davie, FL 33328-2001 | 2020-10-28 |
| 1487252417 | Janice Reaume | Dermatology | 3335 Imperial Manor Way, Mulberry, FL 33860-5519 | 2020-10-12 |
| 1922617729 | Synergymd, LLC | Dermatology | 1208 E Kennedy Blvd Ste 221, Tampa, FL 33602-3509 | 2020-07-28 |
| 1518585447 | Alexander F Wong | Dermatology | 1300 Goodlette-frank Rd N, Naples, FL 34102-5243 | 2020-07-07 |
| 1508495003 | Elite Dermatology | Dermatology | 401 Coral Way Ste 207, Coral Gables, FL 33134-4924 | 2020-04-06 |
| 1124668371 | Meaghan Margaret Birakis | Dermatology | 3319 Fl-7 #202, Wellington, FL 33449 | 2020-01-15 |
| 1396380044 | Suzanne Marie Smith | Dermatology | 21097 Ne 27th Ct Ste 500, Miami, FL 33180-1235 | 2019-11-15 |
| 1376188383 | Enchantress Dermatology, Inc. | Dermatology | 241 Nw 119 Ave, Miami, FL 33182-1329 | 2019-11-13 |
| 1699319988 | Revivify Dermatology, LLC | Dermatology | 21301 Powerline Rd # 108, Boca Raton, FL 33433-2388 | 2019-10-30 |
| 1841833928 | Carly Marie Maher | Dermatology | 90 Cypress Way E Ste 50, Naples, FL 34110-9275 | 2019-10-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.