Healthcare Provider Details

I. General information

NPI: 1336023829
Provider Name (Legal Business Name): SHANNON REID PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 UNION BLVD APT 206
SAINT LOUIS MO
63108-1144
US

IV. Provider business mailing address

530 UNION BLVD APT 206
SAINT LOUIS MO
63108-1144
US

V. Phone/Fax

Practice location:
  • Phone: 314-333-2754
  • Fax:
Mailing address:
  • Phone: 314-333-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: