ORLANDO DERMATOLOGY CLINIC, LLC (NPI# 1891257655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891257655 |
| Entity Type | Organization |
| Organization Name | ORLANDO DERMATOLOGY CLINIC, LLC |
| Other Organization Name | CARE DERMATOLOGY AND SKIN CANCER CENTERS |
| Practice Address |
1040 Lake Sumter Lndg The Villages FL 32162-2697 |
| Mailing Address |
697 Oak Hollow Way Altamonte Springs FL 32714-1838 |
| Practice Telephone | 3522183211 |
| Practice Fax Number | 8776993709 |
| Mailing Telephone | 7857606740 |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2020-05-21 |
| Authorized Official Name | DR. TAREK SAMIR SHAATH (DERMATOLOGIST, LLC PRESIDENT) |
| Authorized Official Telephone | 7857606740 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| N | 332900000X | Non-Pharmacy Dispensing Site | Suppliers | ||
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Care Dermatology and Skin Cancer Centers | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427670595 | Orlando Dermatology Clinic, LLC | Non-Pharmacy Dispensing Site | 3261 Us Highway 441/27 Ste F1, Fruitland Park, FL 34731-4495 | 2020-05-12 |
| Street Address |
1040 LAKE SUMTER LNDG |
| City | THE VILLAGES |
| State | FL |
| Zip Code | 32162-2697 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366823775 | Tarek S Shaath | Dermatology | 1040 Lake Sumter Lndg, The Villages, FL 32162-2697 | 2015-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831700939 | Lana Nesheiwat | Pharmacist | 2235 Parr Drive, Lady Lake, FL 32162 | 2020-08-12 |
| 1619591393 | Advanced Periodontics & Implant Care, LLC | Dentist | 1950 Laurel Manor Drive #184, The Villages, FL 32162 | 2020-05-29 |
| 1639719081 | Retirement Five, LLC | Skilled Nursing Facility | 16605 Se 74th Souiliere Ave, The Villages, FL 32162 | 2020-01-14 |
| 1184263261 | Eric William Allen | Pharmacist | Win Dixie Pharmacy #2545, 2500 Burnsed Blvd, The Villages, FL 32162 | 2020-01-06 |
| 1740828391 | Tara Maria Jennings Irwin | Physical Therapy Assistant | 11962 Cr 101 #104, The Villages, FL 32162 | 2019-12-13 |
| 1851819254 | Bio-medical Applications of Florida, Inc. | Clinic/Center | 310 Longview Ave, Lady Lake, FL 32162 | 2017-09-06 |
| 1033642327 | Ben Miller | Specialist/Technologist | 251 Buffalo Trl, The Villages, FL 32162 | 2017-04-04 |
| 1932631173 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 620 Kristine Way, The Villages, FL 32162 | 2017-03-28 |
| 1639534522 | Pamela Marie Bureau | Registered Nurse | 1020 Lake Sumter Landing, The Villages, FL 32162 | 2015-12-21 |
| 1669847059 | Dawn Johnson | Dental Assistant | 8900 Mulberry Ln, The Villages, FL 32162 | 2015-12-10 |
| Find all providers in zip 32162 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619232501 | Alliant Dermatology Pa | Dermatology | 8620 E County Road 466, The Villages, FL 32162-3670 | 2012-07-07 |
| 1417115908 | Leavitt Medical Associates of Florida Inc | Dermatology | 910 Old Camp Rd Ste 166, The Villages, FL 32162-5604 | 2008-05-30 |
| 1700044286 | Leavitt Medical Associates of Florida Inc | Dermatology | 1503 Buenos Aires Blvd, The Villages, FL 32159-6821 | 2008-05-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144827577 | Onspot-fl LLC. | Dermatology | 16461 Domestic Ave, Fort Myers, FL 33912-6008 | 2020-10-08 |
| 1942855150 | International Dermatology Research, Inc. | Dermatology | 8370 W Flagler St Ste 200, Miami, FL 33144-2038 | 2019-08-05 |
| 1154815546 | Forefront Dermatology, S.c. | Dermatology | 7720 Us Highway 98 W Ste 240, Miramar Beach, FL 32550-7232 | 2018-06-19 |
| 1437517802 | Total Vein and Skin LLC | Dermatology | 10383 Hagen Ranch Road, Ste 100, Boynton Beach, FL 33437-3732 | 2016-02-01 |
| 1861812851 | Anand Haryani | Dermatology | 8745 N Us Highway 1, Sebastian, FL 32958-7524 | 2014-04-17 |
| 1164841797 | Michael Montuno | Dermatology | 38135 Market Sq Ste 108, Zephyrhills, FL 33542-7505 | 2014-04-10 |
| 1861813719 | Hillcrest Dermatology and Plastic Surgery P.a. | Dermatology | 733 Highway 466, Lady Lake, FL 32159-6340 | 2013-12-19 |
| 1922355957 | Florida Medical Specialists | Dermatology | 4351 Cortez Rd W, Suite 101, Bradenton, FL 34210 | 2012-08-09 |
| 1114218328 | Leavitt Medical Assocaittes of Florida Inc | Dermatology | 1426 E Bloomindale Ave, Valrico, FL 33596 | 2011-04-21 |
| 1992095681 | Leavitt Medical Associates of Florida Inc | Dermatology | 3427 Mariner Blvd, Spring Hill, FL 34609-2463 | 2011-04-14 |
| Find all providers with the same taxonomy | ||||
| City | THE VILLAGES |
| Zip Code | 32162 |
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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.