Provider Demographics
NPI:1174514020
Name:SHAYKH, MARWAN M (MD)
Entity type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:M
Last Name:SHAYKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 450
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4230
Mailing Address - Country:US
Mailing Address - Phone:904-398-1473
Mailing Address - Fax:904-399-3436
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 450
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4230
Practice Address - Country:US
Practice Address - Phone:904-398-1473
Practice Address - Fax:904-399-3436
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232643207V00000X
FLME 40218207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253855500Medicaid
FL94247OtherBCBSFL
FL94247Medicare PIN
FL94247OtherBCBSFL