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General NPI Number Information
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NPI Number | 1740061811
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Entity Type | Organization
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Legal Business Name | JMBA, LLC
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 15320 CONWAY RD STE B
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2054
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Country | US
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Telephone | 314-806-2229
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Fax | 636-441-7775
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Provider Business Mailing Address
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Address Line | 15320 CONWAY RD STE B
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2054
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Country | US
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Telephone | 314-806-2229
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Fax | 636-441-7775
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHVETHA ZAREK
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Credential | MD
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Telephone | 703-608-5039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number |
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License Number State |
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