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General NPI Number Information
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NPI Number | 1083687859
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Entity Type | Individual
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Provider Name | VIDAL T SHEEN MD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 11144 TESSON FERRY RD SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6965
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Country | US
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Telephone | 314-842-1441
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Fax | 314-842-1402
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Provider Business Mailing Address
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Address Line | 11144 TESSON FERRY RD STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6965
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Country | US
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Telephone | 314-842-1441
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Fax | 877-327-5055
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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 | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 2020018872
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 2020018872
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License Number State | MO
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