Provider Demographics
NPI:1588047427
Name:S.A.I DERMATOLOGY INC
Entity type:Organization
Organization Name:S.A.I DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRETHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARAM-MOHIP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-427-0850
Mailing Address - Street 1:10131 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6156
Mailing Address - Country:US
Mailing Address - Phone:866-427-0850
Mailing Address - Fax:561-282-3238
Practice Address - Street 1:10131 FOREST HILL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6156
Practice Address - Country:US
Practice Address - Phone:866-427-0850
Practice Address - Fax:561-282-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9927207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty