Organization
WATER'S EDGE DERMATOLOGY
Active
Organization
WATER'S EDGE DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA MITCHELL (BILLING DIRECTOR)
(561) 693-0540
Entity
Organization
Contact information
Practice address
7605 CONROY WINDERMERE RD, ORLANDO, FL 32835-2646
(561) 693-0540
(561) 422-4212
Mailing address
2845 PGA BLVD, PALM BEACH GARDENS, FL 33410-2910
(561) 693-0540
(561) 422-4212
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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