Healthcare Provider Details

I. General information

NPI: 1801675186
Provider Name (Legal Business Name): DR MAE SHEIKH ALI ENDOCRINE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S STE 310
JACKSONVILLE FL
32216-4294
US

IV. Provider business mailing address

14286 BEACH BLVD STE 19 BOX 208
JACKSONVILLE FL
32250
US

V. Phone/Fax

Practice location:
  • Phone: 610-529-4165
  • Fax:
Mailing address:
  • Phone: 610-529-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MAE SHEIKH ALI
Title or Position: OWNER
Credential: MD
Phone: 610-529-4165