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General NPI Number Information
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NPI Number | 1023629748
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Entity Type | Individual
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Provider Name | SHELLSEA PORTILLO CANALES MD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | CENTER FOR SPECIALIZED MEDICINE 1225 S GRAND BLVD SECOND FLOOR
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1016
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Country | US
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Telephone | 314-257-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 743 N PARK ST
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City | SAINT LOUIS
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State | MO
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Zip | 63119-1907
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Country | US
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Telephone | 929-523-3782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2023022535
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 2023022535
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License Number State | MO
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