SUNNYCOAST DERMATOLOGY, INC. – Dermatology Physician, NPI 1962487546

SUNNYCOAST DERMATOLOGY, INC. is a healthcare provider. based in Vero beach, Florida. specializing in Dermatology Physician. The organization holds a License No. ME79805 (FL). The NPI Number for SUNNYCOAST DERMATOLOGY, INC. is 1962487546

Main info

Organization
Name
SUNNYCOAST DERMATOLOGY, INC.
NPI
1962487546
Phone
(772) 299-4000
Address
1850 43RD AVE
Authorized Official
THEODOR MAJOR RUDOLPH MEDICAL DIRECTOR/MEDICAL DOCTOR M.D.
Enumeration Date
7 December 2005
Last Update Date
22 August 2020
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

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Provider Addresses for SUNNYCOAST DERMATOLOGY, INC.

  • 1850, 43rd Avenue, Vero Beach, Indian River County, Florida, 32960, United States

    SUITE 4 & 5 C

    VERO BEACH, FL 329600504

    Phone: (772) 299-4000

    Fax: (772) 299-4001

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-04-06

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2023-11-30 (921 days ago).

Enrollment records

1

Earliest due date

2023-11-30

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20040406001729OClinic/Group PracticeFL2023-11-30

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32960)

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Reviews

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Frequently asked questions

Does SUNNYCOAST DERMATOLOGY, INC. share an NPI with anyone else?
NPI numbers are unique to each provider or organization — SUNNYCOAST DERMATOLOGY, INC. uses 1962487546.
Can I rely on SUNNYCOAST DERMATOLOGY, INC. being an active provider?
As of the registry snapshot, SUNNYCOAST DERMATOLOGY, INC. is marked active.
What is SUNNYCOAST DERMATOLOGY, INC.'s specialty?
The listing groups SUNNYCOAST DERMATOLOGY, INC. with Dermatology Physician. Clinical services aligned with this taxonomy classification.
Where should I expect SUNNYCOAST DERMATOLOGY, INC. on a map?
Expect Vero Beach, Florida as a primary anchor for SUNNYCOAST DERMATOLOGY, INC. unless the record lists multiple sites.
Why does SUNNYCOAST DERMATOLOGY, INC. have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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