SHADETREE DERMATOLOGY LLC
NPI 1366297376
Dermatology in Cocoa Beach, FL

Active since April 22, 2024
105 S BANANA RIVER BLVD FL 2, COCOA BEACH, FL 32931(321) 200-0346 Get Directions Write a Review

NPPES record last updated: March 4, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 4, 2026, Aug 4, 2024, Apr 22, 2024 (3 updates tracked since 2024).

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

NPI1366297376
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSHADETREE DERMATOLOGY LLC
Location Address105 S BANANA RIVER BLVD FL 2Cocoa Beach, FL 32931-5041
Mailing Address105 S Banana River Blvd Fl 2Cocoa Beach, FL 32931-5041 · (321) 200-0346
Organization SubpartNo
Authorized OfficialVanessa Emily JohnsonDermatologist (physician) · (321) 200-0346
Enumeration DateApril 22, 2024
Last NPPES UpdateMarch 4, 20263 updates tracked since enumeration
NPPES CertifiedMarch 4, 2026
✔ NPI 1366297376 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.
105 S BANANA RIVER BLVD FL 2, Cocoa Beach, FL 32931

Secondary Practice Location 1

Location 1389 Commerce Pkwy Ste 160Rockledge, FL 32955-4202 · Phone (321) 200-0346

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

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

3

Medicare 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)

Nurse Practitioner
NPI 1225673809
105 S BANANA RIVER BLVD FL 2
Cocoa Beach, FL 32931
(321) 200-0346
✔ PECOS✔ Accepts MedicareSame address
Dermatology
NPI 1972948875
389 COMMERCE PKWY STE 160
Rockledge, FL 32955
(321) 200-0346
✔ PECOS✔ Accepts Medicare7.1 mi
Nurse Practitioner
NPI 1205103884
2120 SARNO RD
Melbourne, FL 32935
(321) 241-6800
✔ PECOS✔ Accepts Medicare15 mi

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.