Organization
THEO MEDICAL DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ATHENA THEODOSATOS DO, MPH (OWNER)
(407) 671-3634
Entity
Organization
Contact information
Practice address
3030 E SEMORAN BLVD STE 258, APOPKA, FL 32703-5900
(407) 671-3634
(407) 986-6033
Mailing address
3030 E SEMORAN BLVD STE 258, APOPKA, FL 32703-5900
(407) 671-3634
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS38457
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001101800
—
FL
Enumeration date
05/16/2013
Last updated
10/16/2025
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