Provider Demographics
NPI:1790066454
Name:MAKUI, SHEYDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEYDA
Middle Name:
Last Name:MAKUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEYDA
Other - Middle Name:
Other - Last Name:TAGHIZADEH MAKOUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4427
Mailing Address - Country:US
Mailing Address - Phone:973-777-0256
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4427
Practice Address - Country:US
Practice Address - Phone:973-777-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09497300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine