Provider Demographics
NPI:1952806531
Name:SKOPIS, PENELOPE KALLIS
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:KALLIS
Last Name:SKOPIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 AVENIDA DEL CIRCO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4108
Mailing Address - Country:US
Mailing Address - Phone:941-484-8222
Mailing Address - Fax:941-486-0316
Practice Address - Street 1:1111 AVENIDA DEL CIRCO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4108
Practice Address - Country:US
Practice Address - Phone:941-484-8222
Practice Address - Fax:941-486-0316
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036160030207N00000X
390200000X
FLME162911207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program