Provider Demographics
NPI:1003582123
Name:SKIN DERMATOLOGY AND COSMETIC SERVICES, P.A.
Entity Type:Organization
Organization Name:SKIN DERMATOLOGY AND COSMETIC SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-525-5993
Mailing Address - Street 1:865 SAXON BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8204
Mailing Address - Country:US
Mailing Address - Phone:386-256-1969
Mailing Address - Fax:407-599-7506
Practice Address - Street 1:84 PINNACLES DR STE 400
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2324
Practice Address - Country:US
Practice Address - Phone:386-256-1969
Practice Address - Fax:407-599-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009563608Medicaid