Healthcare Provider Details

I. General information

NPI: 1972619302
Provider Name (Legal Business Name): JAYE M SHYKEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BELLEVUE AVE SUITE 400
SAINT LOUIS MO
63117-1818
US

IV. Provider business mailing address

6420 CLAYTON RD SUITE 559
SAINT LOUIS MO
63117-1811
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-7455
  • Fax: 314-977-7477
Mailing address:
  • Phone: 314-768-8873
  • Fax: 314-768-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number36312
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: