Organization
BOUTIQUE DERMATOLOGY LLC
Active
Organization
BOUTIQUE DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY FOX (AUTHORIZED OFFICIAL)
(321) 439-9505
Entity
Organization
Contact information
Practice address
1400 S ORLANDO AVE STE 101, WINTER PARK, FL 32789-5543
(407) 305-9195
Mailing address
1400 S ORLANDO AVE STE 101, WINTER PARK, FL 32789-5543
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
08/16/2024
Last updated
08/16/2024
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