Unique Dermatology & Wellness Center PA

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

OS8642 Issued in FL

Legal business name

UNIQUE DERMATOLOGY & WELLNESS CENTER PA

Practice address

4325 Lynx Paw TRL
Valrico, FL 33594-7426

Phone

(813) 684-9600

Fax

(813) 662-9777

NPI assigned

Dec 8, 2006

Last updated

Nov 5, 2019By 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

Dr. Dyan Jenelle Harvey-Dent, D.O.NPI 1245263813

Title

Owner

Phone

(813) 684-9600

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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.

• Dyan Jenelle Harvey-Dent, D.O.

  • Family Medicine Physician
  • Valrico, FL
  • NPI 1245263813
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572912000000",
    "number": "1881754224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4325 LYNX PAW TRL",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335947426",
            "telephone_number": "813-684-9600",
            "fax_number": "813-662-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4325 LYNX PAW TRL",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335947426",
            "telephone_number": "813-684-9600",
            "fax_number": "813-662-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIQUE DERMATOLOGY & WELLNESS CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2019-11-05",
        "status": "A",
        "authorized_official_last_name": "HARVEY-DENT",
        "authorized_official_first_name": "DYAN",
        "authorized_official_middle_name": "JENELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-684-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "OS8642",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "OS8642",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPPLIER #",
            "identifier": "U2552Z",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271359400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Valrico, FL
• Providers in Valrico, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.