Healthcare Provider Details

I. General information

NPI: 1376948604
Provider Name (Legal Business Name): SHENIF LADAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAYNE LADAK

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 DE PAUL DR
BRIDGETON MO
63044-2511
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-9700
  • Fax: 314-447-9812
Mailing address:
  • Phone: 877-749-7428
  • Fax: 512-628-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD2021-0501
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number83332
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2017002247
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2014-01584
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036149937
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number000000064215
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: