Dermatology and Skin Cancer Surgery Center, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY AND SKIN CANCER SURGERY CENTER, LLC

Practice address

7560 Red Bug Lake Rd Ste 1014
Oviedo, FL 32765-6591

Phone

(407) 706-1770

NPI assigned

Aug 18, 2016

Organization subpart

No

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

Authorized official

Name

Vitaly Blatnoy, MDNPI 1669462123

Title

Owner

Phone

(407) 706-1770

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Orlando Dermatology Center 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

Locations

Practitioners 15

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

• Vitaly Blatnoy, MD

  • Dermatology Physician
  • Oviedo, FL
  • NPI 1669462123
  Medicare reassignment Care Compare group Authorized official
• Dilan Kim Ipek

  • Nurse Practitioner
  • Casselberry, FL
  • NPI 1952188633
  Medicare reassignment Care Compare group NPD
• Joanna Kluger-Wesley

  • Physician Assistant
  • Oviedo, FL
  • NPI 1831855543
  Medicare reassignment Care Compare group NPD
• Cassie De Los Angeles, PA-C

  • Medical Physician Assistant
  • Oviedo, FL
  • NPI 1831678572
  Medicare reassignment Care Compare group
• Amanda Courtni Hulce

  • Adult Health Nurse Practitioner
  • Oviedo, FL
  • NPI 1821475724
  Medicare reassignment Care Compare group
• Anam Jaffar, PA

  • Physician Assistant
  • Orlando, FL
  • NPI 1255986428
  Medicare reassignment Care Compare group
• Timothy Nyckowski, DO

  • Dermatology Physician
  • Lake Mary, FL
  • NPI 1003313735
  Medicare reassignment Care Compare group
• Elena Shumsky, NP

  • Nurse Practitioner
  • Orlando, FL
  • NPI 1427224237
  Medicare reassignment Care Compare group
• Stella G Terenteva, ARNP

  • Nurse Practitioner
  • Lake Mary, FL
  • NPI 1225352610
  Medicare reassignment Care Compare group
• Mikhail Vaysberg, DO

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Oviedo, FL
  • NPI 1083639561
  Medicare reassignment Care Compare group
• Richard Gerald Levine, MD, FAAD

  • Dermatology Physician
  • Asheville, NC
  • NPI 1700997988

  FL

  Medicare reassignment NPD
• Sarah Cordero, APRN, FNP-C

  • Family Nurse Practitioner
  • Lake Mary, FL
  • NPI 1235895574
  Medicare reassignment

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

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1174078281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7560 RED BUG LAKE RD STE 1014",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327656591",
            "telephone_number": "407-706-1770",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7560 RED BUG LAKE RD STE 1014",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327656591",
            "telephone_number": "407-706-1770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4970 S US Highway 17/92",
            "address_purpose": "LOCATION",
            "city": "Casselberry",
            "state": "FL",
            "postal_code": "327073888",
            "country_code": "US",
            "telephone_number": "407-635-8012",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "731 Stirling Center Pl",
            "address_purpose": "LOCATION",
            "city": "Lake Mary",
            "state": "FL",
            "postal_code": "327465209",
            "country_code": "US",
            "telephone_number": "407-436-7375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "422 S Alafaya Trl Ste 26",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328288984",
            "country_code": "US",
            "telephone_number": "407-538-3855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMATOLOGY AND SKIN CANCER SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-18",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "BLATNOY",
        "authorized_official_first_name": "VITALY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-706-1770",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001633600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orlando Dermatology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.