Healthcare Provider Details

I. General information

NPI: 1104442748
Provider Name (Legal Business Name): AASHRAY SINGAREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MEDICAL PLZ
LAKE SAINT LOUIS MO
63367-1490
US

IV. Provider business mailing address

400 MEDICAL PLZ
LAKE SAINT LOUIS MO
63367-1490
US

V. Phone/Fax

Practice location:
  • Phone: 636-639-8600
  • Fax:
Mailing address:
  • Phone: 636-639-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026014017
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: