Healthcare Provider Details

I. General information

NPI: 1053887612
Provider Name (Legal Business Name): ST. GIANNA PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7387 WATSON ROAD
SHREWSBURY MO
63119
US

IV. Provider business mailing address

7387 WATSON ROAD
SHREWSBURY MO
63119
US

V. Phone/Fax

Practice location:
  • Phone: 314-500-5437
  • Fax: 314-500-5683
Mailing address:
  • Phone: 314-500-5437
  • Fax: 314-500-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH C. ABRAHAM
Title or Position: PRESIDENT
Credential: MD
Phone: 314-808-5354