Healthcare Provider Details

I. General information

NPI: 1720105281
Provider Name (Legal Business Name): SANDRA D DUARTE-SCKELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S JEFFERSON AVE STE 118
SAINT LOUIS MO
63118-3907
US

IV. Provider business mailing address

1063 FRUIT TREE LN
SAINT LOUIS MO
63146-4514
US

V. Phone/Fax

Practice location:
  • Phone: 314-776-7999
  • Fax: 314-772-2257
Mailing address:
  • Phone: 314-898-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2004018041
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number046068
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD12964
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2010027261
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: