MEDICARE: SHANNON MICHELLE ROOT BAST PA

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	363A00000X	Physician Assistant	2020023147	MO

General Provider Information

NPI Number	:	1760946669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MICHELLE ROOT BAST PA

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12266 DE PAUL DR STE 205
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2514
Country	:	US
Telephone Number	:	314-218-2300
Fax Number	:

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	03/06/2026

Similar Medicare Providers

1154327039 — STANLEY I BIEL M.D.
Practice Location Address:

12266 DE PAUL DR STE 205
BRIDGETON, MO
63044-2514

Practice Phone: 314-218-2300
Practice Fax:

1760483101 — DR. PETER FONSECA M.D.
Practice Location Address:

12266 DE PAUL DR STE 205
BRIDGETON, MO
63044-2514

Practice Phone: 314-647-8269
Practice Fax:

1962495952 — ELIE C AZRAK MD
Practice Location Address:

12266 DE PAUL DR STE 205
BRIDGETON, MO
63044-2514

Practice Phone: 314-218-2300
Practice Fax:

1215994892 — DR. ARDAMAN S. NANDA M.D.
Practice Location Address:

12266 DE PAUL DR , 205
BRIDGETON, MO
63044-2514

Practice Phone: 314-218-2300
Practice Fax: 314-218-2319

1952354094 — CHRISTIN A PRATHER ACNP
Practice Location Address:

12266 DE PAUL DR STE 210
BRIDGETON, MO
63044-2514

Practice Phone: 314-344-6800
Practice Fax:

1750329611 — WAQAR U. MIRZA M.D.
Practice Location Address:

12266 DE PAUL DRIVE , SUITE 225
BRIDGETON, MO
63044-2514

Practice Phone: 314-881-2700
Practice Fax: 314-881-2706

Directions to “ SHANNON MICHELLE ROOT BAST PA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.