Provider Demographics
NPI:1225297427
Name:YEYKAL, ELSIE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:MARIE
Last Name:YEYKAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:MARIE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1548 ANSLEY PL
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5208
Mailing Address - Country:US
Mailing Address - Phone:810-441-4941
Mailing Address - Fax:
Practice Address - Street 1:6871 BELFORT OAKS PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6242
Practice Address - Country:US
Practice Address - Phone:904-674-0022
Practice Address - Fax:904-425-0192
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17022207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070649Medicaid
MI0F96004OtherMEDICARE GROUP NUMBER
OHH119570Medicare PIN