MEDICARE: DR. SHAHEEN MANSOOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	2005018491	MO
2	2084P0800X	Psychiatry Physician	2010015945	MO

General Provider Information

NPI Number	:	1003017369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHEEN MANSOOR M.D.

Provider Business Mailing Address
First Line	:	10012 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-1826
Country	:	US
Telephone Number	:	314-462-9107
Fax Number	:

Provider Business Practice Location Address
First Line	:	10012 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-1826
Country	:	US
Telephone Number	:	314-462-9107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/21/2024

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