Aesthetic Dermatology PA
Organization Active NPI Dermatology Physician · Clermont, FL
NPI 1225101231 · NPPES record last updated Jan 14, 2025
Key facts
- NPI
- 1225101231
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- AESTHETIC DERMATOLOGY PA
- Practice address
- 210 N Highway 27 Ste 1
Clermont, FL 34711-2411 - Phone
- (352) 243-2544
- Fax
- (352) 243-2745
- NPI assigned
- Nov 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. David L Allyn, MD
- Title
- Medical Director
- Phone
- (352) 243-2544
Practitioners 5
-
David L Allyn, MD
-
Melinda R Short-Russell, MSN, APRN, FNP-BC
-
Kemille Okelia Bell, ARNP
-
Karolina Bugajny, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080814000261 | FL | Part B Supplier - Clinic/Group Practice | 6507931284 |
Receives reassigned benefits from 2 practitioners Practice locations: Clermont, FL; Lady Lake, FL |
National Provider Directory
Locations
210 N Highway 27
Ste 1
Clermont, FL 34711
Phone (352) 243-2544
Interoperability endpoints
- dlallyn@directaddress.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | ME70658 | FL | |
| Dermatology Physician |
207N00000X | Yes | ||
| MOHS-Micrographic Surgery Physician |
207ND0101X | |||
| Procedural Dermatology Physician |
207NS0135X |
Addresses
Primary practice location
210 N Highway 27 Ste 1
Clermont, FL 34711-2411
Mailing address
210 North Highway 27
Suite 1
Clermont, FL 34711
Phone (352) 243-2544
Other practice location 1
13953 NE 86th Ter Ste 100
Lady Lake, FL 32159-6832
Phone (352) 243-2544
Other practice location 2
2701 Rew Cir
Ocoee, FL 34761-2991
Phone (321) 732-5807
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116894500 | Medicaid | FL | |
| 011965403 | Medicaid | FL | |
| 011965400 | Medicaid | FL |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dlallyn@directaddress.net | Direct |
Other providers in Clermont, FL
- Adventist Health System-Sunbelt, Inc
- Adventist Health System/Sunbelt Inc
- Adventist Health System/Sunbelt, Inc
- Adventist Health System/Sunbelt, Inc
- Aendira Medical LLC
- Mohammad Afzal
- Agape Compassionate Care
- Amitesh Agarwal
- Alka Aggarwal
- Amit Aggarwal
All providers in Clermont, FL · Dermatology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.