Provider Demographics
NPI:1316545718
Name:SHWKET, SHAIMAA MAHMOUD (OD)
Entity Type:Individual
Prefix:
First Name:SHAIMAA
Middle Name:MAHMOUD
Last Name:SHWKET
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SAN FRANCISCO DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4109
Mailing Address - Country:US
Mailing Address - Phone:908-202-0307
Mailing Address - Fax:
Practice Address - Street 1:565 NEW BRUNSWICK AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2162
Practice Address - Country:US
Practice Address - Phone:732-738-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00701000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist