Sun State Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SUN STATE DERMATOLOGY, LLC

Practice address

430 Lake Howell Rd
Maitland, FL 32751-5907

Phone

(407) 636-3113

Fax

(407) 636-3133

NPI assigned

Jul 28, 2023

Organization subpart

No

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

Authorized official

Name

Nathoo K Rajiv, MD

Title

Practice Owner

Phone

(407) 636-3113

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00375

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rajiv Kiran Nathoo, MD

  • Dermatology Physician
  • Maitland, FL
  • NPI 1588002059
  Medicare reassignment Care Compare group NPD
• Theresa Helsel, PA-C

  • Physician Assistant
  • Mount Dora, FL
  • NPI 1912336215
  Medicare reassignment Care Compare group
• Kara Lockcuff, PA-C

  • Medical Physician Assistant
  • Maitland, FL
  • NPI 1689448078
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1690502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704499200000",
    "number": "1093496432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515907",
            "telephone_number": "407-636-3113",
            "fax_number": "407-636-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 LAKE HOWELL RD",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515907",
            "telephone_number": "407-636-3113",
            "fax_number": "407-636-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN STATE DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-28",
        "last_updated": "2024-01-06",
        "certification_date": "2024-01-06",
        "status": "A",
        "authorized_official_last_name": "RAJIV",
        "authorized_official_first_name": "NATHOO",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "407-636-3113",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle L Sullivan, LMHC
• Zhyani Sullivan
• Andrew G Summers, MD
• Zachary Summers, DPT
• Summerwood Home Health Services of District 7, LLC
• Sunshine Interventional Pain and Wellness Center LLC
• Sunshine Pediatrics of Central Florida
• Sunshine Pediatrics of Central Florida, PL
• Stefanie Supenia, RCSWI
• Aravinthan Suppiah, M.B:CH.B

• Dermatology Physician in Maitland, FL
• Providers in Maitland, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.