=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366565723
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA SHAPP CARUSA PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 CHESTERFIELD CTR STE 400
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-606-5360
-----------------------------------------------------
Fax | 314-529-3530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5414 NORTHERN LIGHTS DR
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80528-4433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-606-5360
-----------------------------------------------------
Fax | 314-529-3530
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 01934
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 01934
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------