Healthcare Provider Details

I. General information

NPI: 1902109481
Provider Name (Legal Business Name): MARWAN M. SHAYKH, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S SUITE 450
JACKSONVILLE FL
32216-4230
US

IV. Provider business mailing address

3627 UNIVERSITY BLVD S SUITE 450
JACKSONVILLE FL
32216-4230
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-1473
  • Fax: 904-399-3436
Mailing address:
  • Phone: 904-398-1473
  • Fax: 904-399-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number40218
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number0101232643
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number40218
License Number StateFL

VIII. Authorized Official

Name: DR. MARWAN M SHAYKH
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 904-398-1473