Healthcare Provider Details

I. General information

NPI: 1619774866
Provider Name (Legal Business Name): NARDEEN AYAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL MSC 8116-0043-09
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

1 CHILDRENS PL MSC 8116-0043-09
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6018
  • Fax: 844-621-4392
Mailing address:
  • Phone: 314-454-6018
  • Fax: 844-621-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025014115
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: