Healthcare Provider Details

I. General information

NPI: 1871795104
Provider Name (Legal Business Name): SHEHLA SADIQ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 VISTA AVE # 2104
SAINT LOUIS MO
63110-2540
US

IV. Provider business mailing address

232 N KINGSHIGHWAY BLVD APT 618
SAINT LOUIS MO
63108-1248
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-8462
  • Fax: 314-771-8575
Mailing address:
  • Phone: 914-740-5481
  • Fax: 314-771-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number2006021633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: