Shadetree Dermatology LLC
NPI 1366297376 · Dermatology Physician · Cocoa Beach, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Shadetree Dermatology LLC is a Dermatology Physician organization in Cocoa Beach, FL (NPI 1366297376).
Provider details
- NPI number
- 1366297376
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Vanessa Johnson, Dermatologist (physician)(321) 200-0346
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (1)
- 389 Commerce Pkwy Ste 160Rockledge, FL 32955-4202Phone: (321) 200-0346
Registry dates
- Enumerated
- 2024-04-22
- Last updated
- 2026-03-04
- Certified
- 2026-03-04
Frequently asked questions
- What is Shadetree Dermatology LLC's NPI number?
- Shadetree Dermatology LLC's National Provider Identifier (NPI) is 1366297376, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Shadetree Dermatology LLC?
- Shadetree Dermatology LLC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Shadetree Dermatology LLC located?
- Shadetree Dermatology LLC's practice location on file with NPPES is 105 S Banana River Blvd Fl 2, Cocoa Beach, FL 32931-5041.
- What is Shadetree Dermatology LLC's phone number?
- The practice phone number listed in the NPPES registry for Shadetree Dermatology LLC is (321) 200-0346.
- Does Shadetree Dermatology LLC accept Medicare?
- Shadetree Dermatology LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Shadetree Dermatology LLC?
- The authorized official listed on Shadetree Dermatology LLC's NPPES record is Vanessa Johnson, Dermatologist (physician). The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Shadetree Dermatology LLC's NPI active?
- Yes — Shadetree Dermatology LLC's NPI (1366297376) is active in the NPPES registry as of the last update on 2026-03-04.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.