MEDICARE: ELONA DANAIL BEVLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	M137042022	MO

General Provider Information

NPI Number	:	1700361672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELONA DANAIL BEVLY

Provider Business Mailing Address
First Line	:	1822 DUNNIDEER DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-3004
Country	:	US
Telephone Number	:	314-817-7043
Fax Number	:

Provider Business Practice Location Address
First Line	:	1822 DUNNIDEER DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-3004
Country	:	US
Telephone Number	:	314-817-7043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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Directions to “ ELONA DANAIL BEVLY ” Practice Location

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