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General NPI Number Information
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NPI Number | 1720280175
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Entity Type | Individual
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Provider Name | SHANNON GRACE FARMAKIS MD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 615 S NEW BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8221
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Country | US
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Telephone | 314-251-6031
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Fax | 314-251-6343
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Provider Business Mailing Address
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Address Line | 11475 OLDE CABIN RD STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7129
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Country | US
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Telephone | 314-991-8200
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Fax | 314-991-8206
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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 | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | M-14782
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | MD60962082
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0444325
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M-14782
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 200813456
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License Number State | MO
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