Healthcare Provider Details

I. General information

NPI: 1952232480
Provider Name (Legal Business Name): DIVINE LONGEVITY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 FOUR SEASONS SHOPPING CTR STE 110
CHESTERFIELD MO
63017-3173
US

IV. Provider business mailing address

106 FOUR SEASONS SHOPPING CTR STE 110
CHESTERFIELD MO
63017-3173
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-5364
  • Fax:
Mailing address:
  • Phone: 314-514-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KHASHAYAR JOHN ARSHADI
Title or Position: OWNER
Credential: MD
Phone: 314-514-5364