Healthcare Provider Details

I. General information

NPI: 1346295490
Provider Name (Legal Business Name): NALINI K MEHTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 LEMP AVE SOULARD BENTON HEALTH CENTER
SAINT LOUIS MO
63104-2700
US

IV. Provider business mailing address

1717 BIDDLE ST
SAINT LOUIS MO
63106-3454
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-8531
  • Fax: 314-814-8542
Mailing address:
  • Phone: 314-814-8531
  • Fax: 314-814-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR3G84
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR3G84
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: