Healthcare Provider Details

I. General information

NPI: 1275045320
Provider Name (Legal Business Name): SHAYNA DEVORAH ROCKOVE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ST. LUKE'S CENTER DR. SUITE 303 A
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

121 ST. LUKE'S CENTER DR. SUITE 303 A
CHESTERFIELD MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-3278
  • Fax: 314-364-5309
Mailing address:
  • Phone: 314-434-3278
  • Fax: 314-590-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017035520
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: