Boutique Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BOUTIQUE DERMATOLOGY LLC

Practice address

1400 S Orlando Ave Ste 101
Winter Park, FL 32789-5543

Phone

(407) 305-9195

NPI assigned

Aug 16, 2024

Organization subpart

No

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

Authorized official

Name

Shelley FoxNPI 1255603817

Title

Authorized Official

Phone

(321) 439-9505

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00425

Practitioners 1

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

• Shelley Hannah Fox, DNP, FNP-BC

  • Family Nurse Practitioner
  • Maitland, FL
  • NPI 1255603817
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1723766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1336971449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S ORLANDO AVE STE 101",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S ORLANDO AVE STE 101",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895543",
            "telephone_number": "407-305-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUTIQUE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-16",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "321-439-9505"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boundless Potentials LLC
• Amanda Bouque, AP
• Naomi Bourassa, MSW
• Laura Bourdeau
• Paul Francis Bourque, CO
• Peter Bove, M.D.
• Brandon Boyd, MA
• Joseph Barry Boyd, M.D.
• Sheryl Boyd
• William Lewis Boyd, MA, NCC

• Dermatology Physician in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.