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ORLANDO DERMATOLOGY CLINIC, LLC
NPI 1043900947
Dermatology in Orange City, FL

Active since May 12, 2023CLIA Certified · 2 labs
2548 S VOLUSIA AVE, ORANGE CITY, FL 32763(352) 218-3211 Get Directions Write a Review

NPPES record last updated: November 24, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 24, 2023, May 12, 2023 (2 updates tracked since 2023).

About Orlando Dermatology Clinic, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ORLANDO DERMATOLOGY CLINIC, LLC (NPI 1043900947) is a healthcare organization registered as a dermatology in Orange City, Florida and active in the NPI registry since May 2023. The organization holds 2 active CLIA laboratory certificates and lists Tarek S Shaath, Owner, as its authorized official.

NPPES Registry Identity

NPI1043900947
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameORLANDO DERMATOLOGY CLINIC, LLC
Location Address2548 S VOLUSIA AVEOrange City, FL 32763-9124
Mailing Address1040 Lake Sumter LndgThe Villages, FL 32162-2697
Phone(352) 218-3211
Organization SubpartNo
Authorized OfficialTarek S ShaathOwner · (352) 218-3211
Enumeration DateMay 12, 2023
Last NPPES UpdateNovember 24, 20232 updates tracked since enumeration
NPPES CertifiedNovember 24, 2023
✔ NPI 1043900947 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
2548 S VOLUSIA AVE, Orange City, FL 32763
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Avera Health Plans, Baylor Scott and White Health Plan and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 10D2323638

Orlando Dermatology Clinic LLC · Orange City, FL
Active · expires May 8, 2027
CLIA Number10D2323638
Laboratory TypePhysician Office
Certificate Effective DateMay 9, 2025
Certificate Expiration DateMay 8, 2027
Laboratory DirectorTarek S. Shaath
Laboratory Phone(321) 237-2537
Laboratory LocationOrlando Dermatology Clinic LLC2548 S Volusia Ave, Orange City, FL 32763
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 10D2189526

Orlando Dermatology Clinic LLC · The Villages, FL
Active · expires Jun 9, 2027
CLIA Number10D2189526
Laboratory TypePhysician Office
Certificate Effective DateJune 10, 2025
Certificate Expiration DateJune 9, 2027
Laboratory DirectorTarek S. Shaath
Laboratory Phone(352) 218-3211
Laboratory LocationOrlando Dermatology Clinic LLC1040 Lake Sumter Landing, The Villages, FL 32162
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DENIS J GULLIVER DCPA
Chiropractor
2548 S VOLUSIA AVE
ORANGE CITY, FL 32763
Volusia County (386) 775-3223

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Orlando Dermatology Clinic, LLC's NPI number?

The NPI number for Orlando Dermatology Clinic, LLC is 1043900947. It was assigned to this organization in the NPPES registry on May 12, 2023.

Where is Orlando Dermatology Clinic, LLC located?

Orlando Dermatology Clinic, LLC is located at 2548 S Volusia Ave, Orange City, FL 32763. The listed phone number is (352) 218-3211.

What is Orlando Dermatology Clinic, LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Orlando Dermatology Clinic, LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Orlando Dermatology Clinic, LLC accept?

Health plans from Anthem Blue Cross and Blue Shield, Avera Health Plans, Baylor Scott and White Health Plan, Blue Cross and Blue Shield of Kansas City and BlueCross BlueShield of Tennessee and 11 other insurers list Orlando Dermatology Clinic, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Orlando Dermatology Clinic, LLC was last updated on November 24, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.