Provider Demographics
NPI:1023334976
Name:STELTON, CHRISTINA DUCKWORTH (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DUCKWORTH
Last Name:STELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:BEATRIZ
Other - Last Name:DUCKWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3093
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-0993
Mailing Address - Country:US
Mailing Address - Phone:941-745-7311
Mailing Address - Fax:941-745-7903
Practice Address - Street 1:446 TAMIAMI TRL S
Practice Address - Street 2:#2
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2630
Practice Address - Country:US
Practice Address - Phone:941-483-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-18
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126862207ZP0102X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017044900Medicaid
FL017044900Medicaid