Healthcare Provider Details

I. General information

NPI: 1831620004
Provider Name (Legal Business Name): SAMI KAMEEL SAIKALY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 STATE ROAD 207
ST AUGUSTINE FL
32084-5938
US

IV. Provider business mailing address

665 STATE ROAD 207 STE 108
ST AUGUSTINE FL
32084-5939
US

V. Phone/Fax

Practice location:
  • Phone: 904-325-6165
  • Fax: 904-944-3044
Mailing address:
  • Phone: 904-325-6165
  • Fax: 904-944-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME149771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: