Organization
UNIQUE DERMATOLOGY & WELLNESS CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DYAN JENELLE HARVEY-DENT D.O. (OWNER)
(813) 684-9600
Entity
Organization
Contact information
Practice address
4325 LYNX PAW TRL, VALRICO, FL 33594-7426
(813) 684-9600
(813) 662-9777
Mailing address
4325 LYNX PAW TRL, VALRICO, FL 33594-7426
(813) 684-9600
(813) 662-9777
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
OS8642
FL
261QP2300X
Primary Care Clinic/Center
OS8642
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271359400
—
FL
01
—
U2552Z
SUPPLIER #
FL
Enumeration date
12/08/2006
Last updated
11/05/2019
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