Healthcare Provider Details

I. General information

NPI: 1083350532
Provider Name (Legal Business Name): SOWMYA YENNAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 07/08/2026
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S EUCLID AVE DEPT OPTHALMOLOGY, 1ST FL
SAINT LOUIS MO
63110-1007
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3431
  • Fax: 866-505-8818
Mailing address:
  • Phone: 314-362-3431
  • Fax: 866-505-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2026017114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: