Leavitt Medical Associates of Florida Inc
Organization Active NPI Dermatology Physician · Boca Raton, FL
NPI 1487812947 · NPPES record last updated Dec 4, 2014
Key facts
- NPI
- 1487812947
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- Practice address
- 1905 Clint Moore Rd
Suite 103
Boca Raton, FL 33496-2658 - Phone
- (561) 241-4474
- Fax
- (561) 241-9667
- NPI assigned
- May 30, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Authorized official
- Name
- Amy Declue
- Title
- Director, Provider Services
- Phone
- (407) 875-2080
Corporate family (same tax ID) 22
Practitioners 3
-
Shuo Shawn Liu, MD; PHD
-
Sonya Unnoppet, PA
-
Kristin Gregory, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050228000737 | FL | Part B Supplier - Clinic/Group Practice | 4688579311 |
Receives reassigned benefits from 243 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Leavitt Medical Associates of Florida Inc
- Part of
- Leavitt Medical Associates of Florida Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| MOHS-Micrographic Surgery Physician |
207ND0101X | |||
| Family Medicine Physician |
207Q00000X | |||
| Plastic Surgery Physician |
208200000X |
Addresses
Primary practice location
1905 Clint Moore Rd
Suite 103
Boca Raton, FL 33496-2658
Mailing address
151 Southhall LN
Ste 300
Maitland, FL 32751-7176
Phone (407) 875-2080
Other names
- Advanced Dermatology and Cosmetic Sur
Other providers in Boca Raton, FL
- Mark Leager
- Marisa Leal
- Janet R. Leathem
- Leavitt Medical Associates of Florida Inc
- Leavitt Medical Associates of Florida Inc
- Leavitt Medical Associates of Florida Inc
- Sandra M Leber
- Suzanne Denise Leblang
- Jeffrey Lebner
- Andrew Brian Lebovic
All providers in Boca Raton, 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 Dec 4, 2014. 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.