Provider Demographics
NPI:1043675853
Name:PUCCI, SHEA (MS)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:PUCCI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10424 SW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7622
Mailing Address - Country:US
Mailing Address - Phone:954-632-4408
Mailing Address - Fax:
Practice Address - Street 1:4200 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6210
Practice Address - Country:US
Practice Address - Phone:954-647-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist