Healthcare Provider Details

I. General information

NPI: 1497617336
Provider Name (Legal Business Name): EMILY SEBALJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13944 REFLECTION DR APT 136
BALLWIN MO
63021-8053
US

IV. Provider business mailing address

13944 REFLECTION DR APT 136
BALLWIN MO
63021-8053
US

V. Phone/Fax

Practice location:
  • Phone: 314-640-0988
  • Fax: 314-640-0988
Mailing address:
  • Phone: 314-640-0988
  • Fax: 314-640-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: