Provider Demographics
NPI:1598031957
Name:JECKELL, AARON SLONE (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:SLONE
Last Name:JECKELL
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 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-888-3666
Mailing Address - Fax:954-753-8334
Practice Address - Street 1:9600 W SAMPLE RD STE 505
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4037
Practice Address - Country:US
Practice Address - Phone:954-888-3666
Practice Address - Fax:954-753-8334
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1473442084P0800X
TNMD528262084P0804X
TN528262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110117000Medicaid