Healthcare Provider Details

I. General information

NPI: 1992963508
Provider Name (Legal Business Name): CARRIE DAVIDOFF STUCKEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ROYAL PALM WAY STE 100
PALM BEACH FL
33480-4325
US

IV. Provider business mailing address

324 ROYAL PALM WAY STE 100
PALM BEACH FL
33480-4325
US

V. Phone/Fax

Practice location:
  • Phone: 561-560-7600
  • Fax:
Mailing address:
  • Phone: 561-560-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD446607
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME115676
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number232822
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: