Leavitt Medical Associates of Florida Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC

Doing business as

Advanced Dermatology and Cosmetic Surgery

Practice address

14050 Town Loop Blvd Ste 203
Orlando, FL 32837-6190

Phone

(407) 852-6650

Fax

(407) 852-6035

NPI assigned

May 30, 2008

Last updated

Apr 21, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

LEAVITT MEDICAL ASSOCIATES OF FLORIDA INCAs reported in NPPES

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

Authorized official

Name

Amy Declue

Title

Director, Provider Services

Phone

(407) 875-2080

Specialties & licenses 3

Addresses

Other names 1

• Advanced Dermatology and Cosmetic Surgery Doing business as

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

Part of

Leavitt Med

Practitioners 6

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.

• Bobbie Ferrell, ARNP

  • Nurse Practitioner
  • Lakeland, FL
  • NPI 1184961419
  NPD
• Rachel Henshaw, ARNP

  • Family Nurse Practitioner
  • Fort Myers, FL
  • NPI 1720544810
  NPD
• Hannah Leonard, PA-C

  • Physician Assistant
  • Ormond Beach, FL
  • NPI 1154871887
  NPD
• Warunee Emelia Nowak, PA

  • Medical Physician Assistant
  • Orlando, FL
  • NPI 1215636444
  NPD
• Christi Leigh Saklad-Costello, PA

  • Physician Assistant
  • Palm Coast, FL
  • NPI 1316933880
  NPD
• Chetan Vedvyas, M.D.

  • MOHS-Micrographic Surgery Physician
  • Punta Gorda, FL
  • NPI 1427342203
  NPD

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271808000000",
    "number": "1104084672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 LAKE LUCIEN DR STE 180",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517235",
            "telephone_number": "407-875-2080",
            "fax_number": "407-875-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14050 TOWN LOOP BLVD STE 203",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328376190",
            "telephone_number": "407-852-6650",
            "fax_number": "407-852-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "enumeration_date": "2008-05-30",
        "last_updated": "2010-04-21",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER SERVICES",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Cosmetic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morgan Patricia Leary, P.T.
• Ryan Leary
• Valerie Deshawn Leath, PHARMD
• Jessica Leather
• Lina Esmeraldo Leavens
• Leavitt Medical Associates of Florida Inc (Advanced Dermatology and Cosmetic Surgery)
• Leavitt Medical Associates of Florida Inc (Advanced Dermatology and Cosmetic Surgery)
• Leavitt Medical Associates of Florida Inc (Advanced Dermatology and Cosmetic Surgery)
• Anna Leavitt, BS, BCABA
• Debra Anne Leavitt, PTA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; 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.