Healthcare Provider Details

I. General information

NPI: 1841618543
Provider Name (Legal Business Name): ASHA RICCIUTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHA BALAKRISHNAN MD

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

3655 VISTA AVE
SAINT LOUIS MO
63110-2539
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-4330
  • Fax: 314-773-1167
Mailing address:
  • Phone: 314-977-4330
  • Fax: 314-773-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2022032145
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD462861
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: