SHADETREE DERMATOLOGY LLC
NPI 1366297376
Dermatology in Cocoa Beach, FL
About Shadetree Dermatology Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHADETREE DERMATOLOGY LLC (NPI 1366297376) is a healthcare organization registered as a dermatology in Cocoa Beach, Florida and active in the NPI registry since April 2024. The organization maintains a secondary practice location in Rockledge and lists Vanessa Emily Johnson, Dermatologist (physician), as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shadetree Dermatology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Shadetree Dermatology LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (3)
Cocoa Beach, FL 32931
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Shadetree Dermatology LLC's NPI number?
The NPI number for Shadetree Dermatology LLC is 1366297376. It was assigned to this organization in the NPPES registry on April 22, 2024.
Where is Shadetree Dermatology LLC located?
Shadetree Dermatology LLC is located at 105 S Banana River Blvd Fl 2, Cocoa Beach, FL 32931. The listed phone number is (321) 200-0346.
What is Shadetree Dermatology LLC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Shadetree Dermatology LLC enrolled in Medicare?
Yes. Shadetree Dermatology LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Shadetree Dermatology LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Shadetree Dermatology LLC, in Dermatology and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Shadetree Dermatology LLC was last updated on March 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months 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.