Provider Demographics
NPI:1043655186
Name:SHEIKH, JAZAB ALI (MD)
Entity type:Individual
Prefix:
First Name:JAZAB
Middle Name:ALI
Last Name:SHEIKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAZAB
Other - Middle Name:
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:401 N CARTER RD STE 201
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1281
Practice Address - Country:US
Practice Address - Phone:302-514-3371
Practice Address - Fax:302-653-3876
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0024863207Q00000X
MDD81068207Q00000X
WAMD60942724207Q00000X
MO2018012912207Q00000X
VA0101259712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2127955Medicaid