Healthcare Provider Details

I. General information

NPI: 1740399724
Provider Name (Legal Business Name): SHERIFA FATIMA IQBAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 GRUPP RD UNIT 31035
SAINT LOUIS MO
63131-5002
US

IV. Provider business mailing address

1015 GRUPP RD UNIT 31035
SAINT LOUIS MO
63131-5002
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-4732
  • Fax: 314-754-8194
Mailing address:
  • Phone: 314-966-4732
  • Fax: 314-754-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16059
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD210003065
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number185065
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number77916
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2006023682
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: