Healthcare Provider Details

I. General information

NPI: 1396667655
Provider Name (Legal Business Name): ARIELL LASHAY SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11726 SAINT CHARLES ROCK RD STE D
BRIDGETON MO
63044-2631
US

IV. Provider business mailing address

310 S GRAND BLVD APT 1911
SAINT LOUIS MO
63103-2423
US

V. Phone/Fax

Practice location:
  • Phone: 314-557-6443
  • Fax:
Mailing address:
  • Phone: 314-557-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberLC014532777
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: