Provider Demographics
NPI:1861682940
Name:BAKERYWALA, RUBINA Y (MD)
Entity type:Individual
Prefix:DR
First Name:RUBINA
Middle Name:Y
Last Name:BAKERYWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2112
Mailing Address - Country:US
Mailing Address - Phone:904-203-4282
Mailing Address - Fax:564-464-3967
Practice Address - Street 1:2601 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2112
Practice Address - Country:US
Practice Address - Phone:904-203-4282
Practice Address - Fax:564-464-3967
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2452482084N0402X
FLME1095782084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003504400Medicaid