Provider Demographics
NPI:1366491847
Name:TODD, LACUYETUNIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:LACUYETUNIA
Middle Name:S
Last Name:TODD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:603 N FLAMINGO RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028
Mailing Address - Country:US
Mailing Address - Phone:954-435-5100
Mailing Address - Fax:954-435-5816
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:SUITE 350
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-435-5100
Practice Address - Fax:954-435-5816
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME55412207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBT1911836OtherDEA
FLBT1911836OtherDEA
E31282Medicare UPIN