Healthcare Provider Details

I. General information

NPI: 1649267675
Provider Name (Legal Business Name): SABRINA DANISE JORDAN-CHILDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SABRINA DANISE JORDAN-CHILDS M.D.

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N HANLEY RD
SAINT LOUIS MO
63134-2003
US

IV. Provider business mailing address

6121 N HANLEY RD
SAINT LOUIS MO
63134-2003
US

V. Phone/Fax

Practice location:
  • Phone: 314-615-6909
  • Fax: 314-615-0599
Mailing address:
  • Phone: 314-615-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2009018422
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: