Healthcare Provider Details

I. General information

NPI: 1942057526
Provider Name (Legal Business Name): NISHAT ANJUM SHAIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 11/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 SOUTH SPRING AVE ROOM 2703
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

1008 SOUTH SPRING AVE ROOM 2703
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-3237
  • Fax: 314-977-1664
Mailing address:
  • Phone: 314-617-3237
  • Fax: 314-977-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: