Sunnycoast Dermatology, Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME79805 Issued in FL

Legal business name

SUNNYCOAST DERMATOLOGY, INC.

Practice address

1850 43Rd Ave
Suite 4 & 5 C
Vero Beach, FL 32960-0504

Phone

(772) 299-4000

Fax

(772) 299-4001

NPI assigned

Dec 7, 2005

Organization subpart

No

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

Authorized official

Name

Theodor Major Rudolph, M.D.NPI 1700861382

Title

Medical Director/Medical Doctor

Phone

(772) 299-4000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

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

• Theodor Major Rudolph, M.D.

  • Dermatology Physician
  • Vero Beach, FL
  • NPI 1700861382
  Medicare reassignment NPD Authorized official
• Tammy Balatgek, DDS, FAACP

  • Dentist
  • Reading, PA
  • NPI 1790792489
  NPD (past)

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962487546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 43RD AVE",
            "address_2": "SUITE 4 & 5 C",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329600504",
            "telephone_number": "772-299-4000",
            "fax_number": "772-299-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 43RD AVE",
            "address_2": "SUITE 4 & 5 C",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329600504",
            "telephone_number": "772-299-4000",
            "fax_number": "772-299-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNNYCOAST DERMATOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "THEODOR",
        "authorized_official_middle_name": "MAJOR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/MEDICAL DOCTOR",
        "authorized_official_telephone_number": "772-299-4000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME79805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Melissa Sumner Davis, M.A., CCC-SLP
• Suncoast Mental Health Center, Inc.
• Suncoast Mental Health Center, Inc.
• Suncoast Mental Health Ctr.
• Sunland-Vero Beach, LLC
• Sunrise Grace Enterprises LLC
• Sunshine Physical Therapy Clinic
• Sunshine Rd LLC
• Sunshine Rehabilitation Center of Indian River County, Inc.
• Falguni Sura, MD

• Dermatology Physician in Vero Beach, FL
• Providers in Vero Beach, 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 22, 2020; 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.