SUMMER MOON (NPI# 1457765968) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457765968 |
| Entity Type | Individual |
| Full Name | SUMMER MOON |
| Credential | DO |
| Practice Address |
115 Highland Ave N Largo FL 33770 |
| Mailing Address |
115 Highland Ave N Largo FL 33770-2530 |
| Practice Telephone | 7275858591 |
| Practice Fax Number | 7275840614 |
| Mailing Telephone | 7278588591 |
| Mailing Fax Number | 7275840614 |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2018-11-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | OS14644 | FL | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | 5101021452 | MI | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
OS14644 | FL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 34941 Us 19 N, Palm Harbor, FL 346841919 | 7277817080 | 7277717694 |
| 2653 Bruce B Downs Blvd Ste 120a, Wesley Chapel, FL 335449206 | 8135140823 | 8134065167 |
| 115 Highland Ave N, Largo, FL 33770 | 7275858591 | 7275840614 |
| 9170 Oakhurst Rd Ste 1, Seminole, FL 337762112 | 7275173376 | 7275173370 |
| 2329 Sunset Point Rd Ste 201, Clearwater, FL 337651438 | 7274413376 | 7272605145 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427678846 | Summer Marie Moon | Physician Assistant | 1600 Sw Archer Rd, Gainesville, FL 32610-3003 | 2020-04-26 |
| Street Address |
115 HIGHLAND AVE N |
| City | LARGO |
| State | FL |
| Zip Code | 33770 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467005041 | Chelsey Lyn Shepos | Optometrist | 1030 West Bay Dr, Suite 200, Largo, FL 33770 | 2019-07-22 |
| 1407353626 | Michael E Ibrahim | Pharmacist | 1290 West Bay Drive, Largo, FL 33770 | 2018-04-13 |
| 1518413384 | Payton Kuhlenbeck | Anesthesiology | 210 14th Street Sw, Largo, FL 33770 | 2016-08-31 |
| 1639536865 | Ryan Boice | Physical Therapy Assistant | 118 West Bay Drive, Suite 111, Largo, FL 33770 | 2016-01-19 |
| 1508238858 | Alignment Healthcare Florida LLC | Clinic/Center | 1301 2nd Ave., Sw, Largo, FL 33770 | 2015-10-27 |
| 1891161808 | Jessica Nicole Mcglone | Nurse Practitioner | 601 Rosery Rd Ne Apt 1502, Largo, FL 33770 | 2015-08-12 |
| 1033598602 | Demetria Anderson | Counselor | 1301 Seminole Blvd Ste 103, Largo, FL 33770 | 2015-05-28 |
| 1962881821 | Building Blocks Therapy, Pllc | Community/Behavioral Health | 1301 Seminole Blvd Building A Suite 103, Largo, FL 33770 | 2015-05-26 |
| 1578982393 | Lauren Elizabeth Grandpre | Emergency Medicine | 201 14th St. Sw, Largo Medical Center Emergency Department, Largo, FL 33770 | 2014-04-09 |
| 1558700146 | Lawrence G. Staff, Dmd, Pa | Dentist | 2001 West Bay Dr., Lawrence G. Staff, D.m.d., Largo, FL 33770 | 2013-06-18 |
| Find all providers in zip 33770 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770726499 | Whitney Lapolla Delozier | Dermatology | 8787 Bryan Dairy Rd Ste 360, Largo, FL 33777-1260 | 2009-04-10 |
| 1912143603 | Preventative Wound Care Associates LLC | Dermatology | 9956 Sago Point Dr, Largo, FL 33777-4913 | 2008-12-30 |
| 1164679668 | Christopher J Ballard | Dermatology | 11200 Seminole Blvd Ste 205, Largo, FL 33778-3240 | 2008-08-26 |
| 1972596690 | Barbara Christine Williamson | Dermatology | 1400 Mercantile Ln, Ste#110, Largo, MD 20774-5341 | 2005-08-28 |
| 1750895140 | Christina Michelle Baden | Dermatology | 8250 Bryan Dairy Rd Ste 250, Largo, FL 33777-1360 | 2017-11-22 |
| 1528416633 | Erin Lowe | Dermatology | 201 14th St Sw, Largo, FL 33770-3133 | 2016-05-31 |
| 1326496522 | Katherine Weber Braunlich | Dermatology | 201 14th St Sw, Largo, FL 33770-3133 | 2016-05-27 |
| 1568807238 | Dawnielle Endly | Dermatology | 201 14th St Sw, Largo, FL 33770-3133 | 2013-05-07 |
| 1669716395 | Visage Dermatology and Aesthetic Center, LLC | Dermatology | 1400 Mercantile Ln, Suite 110, Largo, MD 20774-5341 | 2012-11-19 |
| 1841555398 | Carolyn Ellis | Dermatology | 2025 Indian Rocks Rd S, Largo, FL 33774-1035 | 2012-07-11 |
| Find all providers in LARGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.