Provider Demographics
NPI:1134123078
Name:PANUCCIO, DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:PANUCCIO
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 1:1200 W SR 434
Mailing Address - Street 2:STE 112
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4957
Mailing Address - Country:US
Mailing Address - Phone:407-869-8747
Mailing Address - Fax:
Practice Address - Street 1:1200 W SR 434
Practice Address - Street 2:STE 112
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4957
Practice Address - Country:US
Practice Address - Phone:407-869-8747
Practice Address - Fax:407-869-8108
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
44215Medicare ID - Type Unspecified
E95288Medicare UPIN