Healthcare Provider Details

I. General information

NPI: 1346863008
Provider Name (Legal Business Name): NAYNA MAINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 08/13/2025
Certification Date: 07/17/2023
Deactivation Date: 01/18/2022
Reactivation Date: 03/08/2023

III. Provider practice location address

1 CHILDRENS PL DIV PED ALLERGY/IMMUNO/PULMO
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2694
  • Fax: 844-231-8913
Mailing address:
  • Phone: 314-454-2694
  • Fax: 844-231-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023026679
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: