Healthcare Provider Details

I. General information

NPI: 1629165220
Provider Name (Legal Business Name): PAUL SHEIKEWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HEALTH PARK BLVD
SAINT AUGUSTINE FL
32086-5776
US

IV. Provider business mailing address

PO BOX 740861
ATLANTA GA
30374-0861
US

V. Phone/Fax

Practice location:
  • Phone: 48-233-4019
  • Fax: 904-829-8649
Mailing address:
  • Phone: 904-819-4539
  • Fax: 904-819-4906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG30422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: