Organization
ORLANDO DERMATOLOGY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAREK S SHAATH (OWNER)
(352) 218-3211
Entity
Organization
Contact information
Practice address
2548 S VOLUSIA AVE, ORANGE CITY, FL 32763-9124
(352) 218-3211
Mailing address
1040 LAKE SUMTER LNDG, THE VILLAGES, FL 32162-2697
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
05/12/2023
Last updated
11/24/2023
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