Healthcare Provider Details

I. General information

NPI: 1700923067
Provider Name (Legal Business Name): SITA KEDIA MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 CLAYTON RD
SAINT LOUIS MO
63124-1874
US

IV. Provider business mailing address

9160 CLAYTON RD
SAINT LOUIS MO
63124-1874
US

V. Phone/Fax

Practice location:
  • Phone: 314-801-8898
  • Fax:
Mailing address:
  • Phone: 314-801-8898
  • Fax: 314-787-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2014010629
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2014010629
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number48880
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2014010629
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: