Provider Demographics
NPI:1336814177
Name:QUINTESSENTIAL MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:QUINTESSENTIAL MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHWEIKEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-640-1941
Mailing Address - Street 1:PO BOX 880854
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-0854
Mailing Address - Country:US
Mailing Address - Phone:833-245-5633
Mailing Address - Fax:
Practice Address - Street 1:573 NW LAKE WHITNEY PL STE 103
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1628
Practice Address - Country:US
Practice Address - Phone:833-245-5633
Practice Address - Fax:833-962-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty