Provider Demographics
NPI:1992963508
Name:STUCKEN, CARRIE DAVIDOFF (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:DAVIDOFF
Last Name:STUCKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9168
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468
Mailing Address - Country:US
Mailing Address - Phone:561-741-0000
Mailing Address - Fax:561-745-4212
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:STE #101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-393-8555
Practice Address - Fax:561-393-1904
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232822208000000X
PAMD446607208000000X
FLME115676208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008970500Medicaid