Aesthetic Dermatology & Surgery Clinique, Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

010132257 Issued in VA

Legal business name

AESTHETIC DERMATOLOGY & SURGERY CLINIQUE, INC

Practice address

3811 Gaskins Rd
Richmond, VA 23233-1436

Phone

(804) 270-6100

Fax

(804) 270-4746

NPI assigned

Apr 3, 2007

Last updated

Sep 16, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gilmar Tadioto

Title

Manager

Phone

(407) 529-5901

Specialties & licenses 1

Addresses

Other names 1

• West End Dermatology Associates Other name

Medicare fee-for-service enrollment

Enrolled in VA

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 7

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.

• Yvonne Knight, MD

  • Dermatology Physician
  • Richmond, VA
  • NPI 1477558682
  Medicare reassignment NPD
• Amy Elizabeth Black, NP-C

  • Nurse Practitioner
  • Richmond, VA
  • NPI 1902994106
  NPD (past)
• Samantha Hancock, PA-C

  • Physician Assistant
  • Fairfax, VA
  • NPI 1518396951
  NPD (past)
• Janaya L. Ogunware, NP

  • Acute Care Nurse Practitioner
  • Richmond, VA
  • NPI 1427353952
  NPD (past)
• Shelley B. Woodley, DNP, FNP-BC

  • Family Nurse Practitioner
  • Glen Allen, VA
  • NPI 1477543387
  NPD (past)
• Mark A Mazak, PA-C

  • Physician Assistant
  • Lakewood, NJ
  • NPI 1285748897
  NPD (past)
• Kathrin Khatereh Nunes, PAC

  • Physician Assistant
  • Chattanooga, TN
  • NPI 1881769305
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789516800000",
    "number": "1194846386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 GASKINS RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232331436",
            "telephone_number": "804-270-6100",
            "fax_number": "804-270-4746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 GASKINS RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232331436",
            "telephone_number": "804-270-6100",
            "fax_number": "804-270-4746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC DERMATOLOGY & SURGERY CLINIQUE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A",
        "authorized_official_last_name": "TADIOTO",
        "authorized_official_first_name": "GILMAR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "407-529-5901",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "010132257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West End Dermatology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West End Dermatology Associates",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "West End Dermatology Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dermatology Physician in Richmond, VA
• Providers in Richmond, VA by specialty
• Dermatology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2026; 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.