Basic Information
| Provider Information | |||||||||
| NPI: | 1669435483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOOKOFF | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 S.W. 87TH AVENUE | ||||||||
| Address2: | SUITE C-340 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331733570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055950109 | ||||||||
| FaxNumber: | 3055957092 | ||||||||
| Practice Location | |||||||||
| Address1: | 7301 W PALMETTO PARK RD | ||||||||
| Address2: | SUITE 105C | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334333458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613928832 | ||||||||
| FaxNumber: | 5613923953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME0059769 | FL | N | Other Service Providers | Specialist | 207K00000X | ME0059769 | FL | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 258442500 | 05 | FL | MEDICAID |