Healthcare Provider Details

I. General information

NPI: 1659208809
Provider Name (Legal Business Name): VANDHNA SHARMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 SUTTON BLVD
MAPLEWOOD MO
63143-3007
US

IV. Provider business mailing address

1132 RUE LA VILLE WALK
CREVE COEUR MO
63141-6261
US

V. Phone/Fax

Practice location:
  • Phone: 314-866-8314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2026018917
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: