Healthcare Provider Details

I. General information

NPI: 1922752591
Provider Name (Legal Business Name): MATTHEW STEPHEN ZIDE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 04/17/2025
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S TAYLOR AVE DEPT PSYCHIATRY, STE 122
SAINT LOUIS MO
63110-1035
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1700
  • Fax: 314-970-9094
Mailing address:
  • Phone: 314-286-1700
  • Fax: 314-970-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022004012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: