Healthcare Provider Details

I. General information

NPI: 1477906212
Provider Name (Legal Business Name): SIBA HAYKAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

800 HOWARD AVE
NEW HAVEN CT
06519-1369
US

V. Phone/Fax

Practice location:
  • Phone: 203-499-7031
  • Fax:
Mailing address:
  • Phone: 203-785-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number283162-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number76109
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number180989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: