Provider Demographics
NPI:1669435483
Name:SHOOKOFF, CHARLENE S (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:S
Last Name:SHOOKOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7800 S.W. 87TH AVENUE
Mailing Address - Street 2:SUITE C-340
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-595-0109
Mailing Address - Fax:305-595-7092
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 302
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2237
Practice Address - Country:US
Practice Address - Phone:561-883-6400
Practice Address - Fax:561-883-6682
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059769174400000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258442500Medicaid
FLF52750Medicare UPIN
FL258442500Medicaid