NPIMap

Organization Active NPI

Academic Alliance in Dermatology, PLLC

Doing business as Academic Alliance in Dermatology

  • Dermatology Physician
  • Tarpon Springs, FL
National Provider Identifier
1245807767
Registry record updated Sep 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ACADEMIC ALLIANCE IN DERMATOLOGY, PLLC
Doing business as
Academic Alliance in Dermatology
Practice address
1005 E Boyer St
Tarpon Springs, FL 34689-5501
Phone
(727) 934-7638
Fax
(727) 944-4052
NPI assigned
Jun 4, 2021
Last updated
Sep 14, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ACADEMIC ALLIANCE IN DERMATOLOGY, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2026

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

Authorized official

Name
Nicole Proffitt
Title
Director of Enrollment & Credential
Phone
(804) 869-6269

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X
Dermatopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0900X
Pediatric Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NP0225X
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

1005 E Boyer St
Tarpon Springs, FL 34689-5501

Mailing address

PO Box 23329
New York, NY 10087-3329

Other names 1

  • Academic Alliance in Dermatology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Panos Vasiloudes MD21 organizations share this tax ID, including this one
Part of
Panos Vasiloudes MD

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1622764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1245807767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23329",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873329",
            "fax_number": "410-873-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 E BOYER ST",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "346895501",
            "telephone_number": "727-934-7638",
            "fax_number": "727-944-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC ALLIANCE IN DERMATOLOGY, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACADEMIC ALLIANCE IN DERMATOLOGY, PLLC",
        "enumeration_date": "2021-06-04",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OF ENROLLMENT & CREDENTIAL",
        "authorized_official_telephone_number": "804-869-6269"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Academic Alliance in Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tarpon Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.