MEDICARE: DR. SANDRA ARIELA SHACHAR-KRASNOFF PH.D.

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	103TC1900X	Counseling Psychologist	PS019197	PA
2	103TC1900X	Counseling Psychologist	2011006689	MO

General Provider Information

NPI Number	:	1881983906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA ARIELA SHACHAR-KRASNOFF PH.D.

Provider Business Mailing Address
First Line	:	4567 WEST PINE BLVD.
Second Line	:	601
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2188
Country	:	US
Telephone Number	:	314-440-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD STE 555
Second Line	:
City	:	RICHMOND HTS
State	:	MO
Zip	:	63117-1265
Country	:	US
Telephone Number	:	314-440-5433
Fax Number	:

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

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	04/02/2021

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