Healthcare Provider Details

I. General information

NPI: 1417395294
Provider Name (Legal Business Name): JASMINE RUE SWANIKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE CAMPUS BOX 8054
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

851 TRAFALGAR CT STE 200E
MAITLAND FL
32751-7420
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-6978
  • Fax:
Mailing address:
  • Phone: 321-422-7155
  • Fax: 407-667-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2025-02650
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2014014261
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: