Healthcare Provider Details

I. General information

NPI: 1821757071
Provider Name (Legal Business Name): SAIRA SAQIB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 04/02/2022
Certification Date: 04/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 304
JACKSONVILLE FL
32216-6287
US

IV. Provider business mailing address

2220 COUNTY ROAD 210 W # 108-177
JACKSONVILLE FL
32259-4058
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-3113
  • Fax: 904-296-3144
Mailing address:
  • Phone:
  • Fax: 904-372-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License NumberME108320
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200900365
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME108320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: