Healthcare Provider Details

I. General information

NPI: 1154416154
Provider Name (Legal Business Name): SHELDON LEONARD DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD STE 48W
CHESTERFIELD MO
63017-3663
US

IV. Provider business mailing address

226 S WOODS MILL RD STE 48W
CHESTERFIELD MO
63017-3663
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-7503
  • Fax: 314-576-2150
Mailing address:
  • Phone: 314-576-7503
  • Fax: 314-576-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR5753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: