Provider Demographics
NPI:1033190632
Name:SHAIKH, KHALEEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALEEL
Middle Name:A
Last Name:SHAIKH
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 1:1800 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2369
Mailing Address - Country:US
Mailing Address - Phone:570-969-7245
Mailing Address - Fax:570-969-7325
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-346-7797
Practice Address - Fax:570-342-9802
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041996E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007983270001Medicaid
PA020028939OtherRR MEDICARE
PA092834Medicare ID - Type Unspecified
D97020Medicare UPIN