Provider Demographics
NPI:1871266213
Name:MYPSYCHMD LLC
Entity Type:Organization
Organization Name:MYPSYCHMD LLC
Other - Org Name:SAIRA SAQIB,MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAQIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-296-3113
Mailing Address - Street 1:2220 COUNTY ROAD 210 W # 108-177
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4058
Mailing Address - Country:US
Mailing Address - Phone:904-296-3113
Mailing Address - Fax:904-372-6175
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6287
Practice Address - Country:US
Practice Address - Phone:904-296-3113
Practice Address - Fax:904-372-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearchGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME108320OtherFLORIDA BOARD OF MEDICINE
FLFS4962052OtherDEA