Provider Demographics
NPI:1154984938
Name:SHUKRI, GHAITH KAMAL
Entity type:Individual
Prefix:
First Name:GHAITH
Middle Name:KAMAL
Last Name:SHUKRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 NW 14TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1655
Mailing Address - Country:US
Mailing Address - Phone:305-243-6387
Mailing Address - Fax:
Practice Address - Street 1:1321 NW 14TH ST STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1655
Practice Address - Country:US
Practice Address - Phone:305-243-6387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1634222084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program