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General NPI Number Information
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NPI Number | 1871795104
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Entity Type | Individual
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Provider Name | SHEHLA SADIQ M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3660 VISTA AVE # 2104
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2540
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Country | US
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Telephone | 314-977-8462
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Fax | 314-771-8575
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Provider Business Mailing Address
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Address Line | 232 N KINGSHIGHWAY BLVD APT 618
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1248
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Country | US
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Telephone | 914-740-5481
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Fax | 314-771-8575
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 2006021633
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License Number State | NY
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