MEDICARE: DIVINE LONGEVITY AND WELLNESS

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1952232480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE LONGEVITY AND WELLNESS

Provider Business Mailing Address
First Line	:	106 FOUR SEASONS SHOPPING CTR STE 110
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3173
Country	:	US
Telephone Number	:	314-514-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 FOUR SEASONS SHOPPING CTR STE 110
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3173
Country	:	US
Telephone Number	:	314-514-5364
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KHASHAYAR JOHN ARSHADI
Credential	:	MD
Telephone Number	:	314-514-5364

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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