Provider Demographics
NPI:1245400803
Name:POON, STACIE M (MT)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:M
Last Name:POON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7469
Mailing Address - Country:US
Mailing Address - Phone:561-967-8888
Mailing Address - Fax:561-264-1830
Practice Address - Street 1:4623 FOREST HILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7469
Practice Address - Country:US
Practice Address - Phone:561-967-8888
Practice Address - Fax:561-641-8303
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA25825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist