Provider Demographics
NPI:1477337988
Name:RISING SUN DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:RISING SUN DERMATOLOGY PLLC
Other - Org Name:RISING SUN DERMATOLOGY & COSMETICS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DERMATOLOGIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:KAMEEL
Authorized Official - Last Name:SAIKALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-377-3471
Mailing Address - Street 1:665 STATE ROAD 207 STE 108
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5939
Mailing Address - Country:US
Mailing Address - Phone:904-325-6165
Mailing Address - Fax:904-944-3044
Practice Address - Street 1:665 STATE ROAD 207
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5938
Practice Address - Country:US
Practice Address - Phone:904-325-6165
Practice Address - Fax:904-944-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty