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General NPI Number Information
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NPI Number | 1649273160
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Entity Type | Individual
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Provider Name | STEPHANIE L SANDBERG D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2005
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 20 PROGRESS POINT PKWY SUITE 206
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City | O FALLON
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State | MO
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Zip | 63368-2206
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Country | US
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Telephone | 636-344-1073
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Fax | 636-344-1075
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Provider Business Mailing Address
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Address Line | 670 MASON RIDGE CENTER DR STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8573
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Country | US
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Telephone | 636-344-1073
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Fax | 636-344-1075
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2004012744
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License Number State | MO
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