Healthcare Provider Details

I. General information

NPI: 1023334976
Provider Name (Legal Business Name): CHRISTINA DUCKWORTH STELTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA BEATRIZ DUCKWORTH M.D.

II. Dates (important events)

Enumeration Date: 04/18/2010
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 TAMIAMI TRL S #2
VENICE FL
34285-2630
US

IV. Provider business mailing address

PO BOX 3093
BOCA RATON FL
33431-0993
US

V. Phone/Fax

Practice location:
  • Phone: 941-483-3319
  • Fax:
Mailing address:
  • Phone: 941-745-7311
  • Fax: 941-745-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME126862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: