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General NPI Number Information
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NPI Number | 1992963508
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Entity Type | Individual
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Provider Name | CARRIE DAVIDOFF STUCKEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 5458 TOWN CENTER RD STE #101
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City | BOCA RATON
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State | FL
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Zip | 33486
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Country | US
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Telephone | 561-393-8555
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Fax | 561-393-1904
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Provider Business Mailing Address
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Address Line | PO BOX 9168
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City | JUPITER
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State | FL
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Zip | 33468
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Country | US
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Telephone | 561-741-0000
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Fax | 561-745-4212
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 232822
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD446607
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME115676
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License Number State | FL
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