Healthcare Provider Details

I. General information

NPI: 1972654358
Provider Name (Legal Business Name): MINI TANDON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 MARYLAND AVE STE 330
CLAYTON MO
63105-3660
US

IV. Provider business mailing address

8301 MARYLAND AVE STE 330
CLAYTON MO
63105-3660
US

V. Phone/Fax

Practice location:
  • Phone: 314-721-3381
  • Fax: 314-721-3384
Mailing address:
  • Phone: 314-721-3381
  • Fax: 314-721-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2004007962
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: