Provider Demographics
NPI:1043222409
Name:STICKLE, SHIRLEY (MD)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:
Last Name:STICKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:HUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3365 BURNS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4302
Mailing Address - Country:US
Mailing Address - Phone:561-626-4000
Mailing Address - Fax:561-493-8172
Practice Address - Street 1:3365 BURNS RD STE 100
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4302
Practice Address - Country:US
Practice Address - Phone:561-626-4000
Practice Address - Fax:561-493-8172
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96483208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91688OtherBCBS