Healthcare Provider Details

I. General information

NPI: 1275569683
Provider Name (Legal Business Name): CLARICE M STAVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOCA RATON REGIONAL HOSPITAL NICU 800 MEADOWS ROAD
BOCA RATON FL
33486
US

IV. Provider business mailing address

800 MEADOWS RD DEPT OF NEONATOLOGY
BOCA RATON FL
33486
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-3360
  • Fax:
Mailing address:
  • Phone: 561-955-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number216321
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME100013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: