Healthcare Provider Details

I. General information

NPI: 1871266213
Provider Name (Legal Business Name): MYPSYCHMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 03/07/2023
Certification Date: 07/15/2022
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: 904-372-6175
Mailing address:
  • Phone: 904-296-3113
  • Fax: 904-372-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAIRA SAQIB
Title or Position: OWNER/ PHYSICIAN
Credential: MD
Phone: 904-296-3113