Healthcare Provider Details

I. General information

NPI: 1376476820
Provider Name (Legal Business Name): VAGINAL SURGERY & UROGYNECOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 370A
SAINT LOUIS MO
63128-5118
US

IV. Provider business mailing address

10004 KENNERLY RD STE 370A
SAINT LOUIS MO
63128-5118
US

V. Phone/Fax

Practice location:
  • Phone: 314-807-8765
  • Fax:
Mailing address:
  • Phone: 314-807-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DIONYSIOS VERONIKIS
Title or Position: PRESIDENT
Credential: MD
Phone: 314-973-0070