NPIMap

Organization Active NPI

Orlando Dermatology Clinic, LLC

  • Dermatology Physician
  • Middleton, FL
National Provider Identifier
1043900947
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ORLANDO DERMATOLOGY CLINIC, LLC
Practice address
2235 Alder Ave
Middleton, FL 34762-6162
Phone
(352) 218-3211
NPI assigned
May 12, 2023
Last updated
Sep 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tarek S ShaathNPI 1366823775
Title
Owner
Phone
(352) 218-3211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

2235 Alder Ave
Middleton, FL 34762-6162

Mailing address

1040 Lake Sumter LNDG
The Villages, FL 32162-2697

National Provider Directory

National Provider Directory
Tax ID family
Orlando Dermatology Clinic LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790640000000",
    "number": "1043900947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 LAKE SUMTER LNDG",
            "city": "THE VILLAGES",
            "state": "FL",
            "postal_code": "321622697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 ALDER AVE",
            "city": "MIDDLETON",
            "state": "FL",
            "postal_code": "347626162",
            "telephone_number": "352-218-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORLANDO DERMATOLOGY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-12",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A",
        "authorized_official_last_name": "SHAATH",
        "authorized_official_first_name": "TAREK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-218-3211"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.