Healthcare Provider Details

I. General information

NPI: 1194354282
Provider Name (Legal Business Name): JULIANNE CARROLL SPIROS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANNE CARROLL PIZZOLATO

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10018 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

10010 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6663
  • Fax:
Mailing address:
  • Phone: 314-255-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2024026579
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberUO7011
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: