Active NPI
Ethar Hajo Ahmed Elsheikh
- Surgery Physician
- Jacksonville, FL
National Provider Identifier
1376380923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- TRN41095
- Practice address
- 655 W 8TH St
Jacksonville, FL 32209-6511 - Phone
- (904) 244-3902
- Fax
- (904) 244-3020
- NPI assigned
- Jul 11, 2024
- Last updated
- Jul 11, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | TRN41095 | FL | Primary |
Addresses
Primary practice location
655 W 8TH St
Jacksonville, FL 32209-6511
Mailing address
959 Prudential Dr
Jacksonville, FL 32207-8565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TRN41095 | FL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720656000000",
"number": "1376380923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "959 PRUDENTIAL DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 W 8TH ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322096511",
"telephone_number": "904-244-3902",
"fax_number": "904-244-3020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELSHEIKH",
"first_name": "ETHAR",
"middle_name": "HAJO AHMED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-11",
"last_updated": "2024-07-11",
"certification_date": "2024-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "FL",
"license": "TRN41095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.