Healthcare Provider Details

I. General information

NPI: 1235679267
Provider Name (Legal Business Name): ALEXANDRA G ST. LOUIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 HEMPSTEAD AVE
MALVERNE NY
11565-1201
US

IV. Provider business mailing address

905 UNIONDALE AVE
UNIONDALE NY
11553-3235
US

V. Phone/Fax

Practice location:
  • Phone: 516-678-0076
  • Fax: 516-763-0981
Mailing address:
  • Phone: 516-509-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number319870
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: