Healthcare Provider Details

I. General information

NPI: 1619993839
Provider Name (Legal Business Name): SHERRYL A DILALLO AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV SURG CT ADULT CARDIO
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE MSC 8234-05-02
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7260
  • Fax: 314-747-0917
Mailing address:
  • Phone: 314-362-7260
  • Fax: 314-362-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number102812
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: