Provider Demographics
NPI:1164142253
Name:BASHARDOST, LEEDA (MD, MHSS, FRCPC)
Entity Type:Individual
Prefix:DR
First Name:LEEDA
Middle Name:
Last Name:BASHARDOST
Suffix:
Gender:F
Credentials:MD, MHSS, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 LACLEDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2061
Mailing Address - Country:US
Mailing Address - Phone:314-861-0911
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF NEUROLOGY
Practice Address - Street 2:660 SOUTH EUCLID AVENUE
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1093
Practice Address - Country:US
Practice Address - Phone:314-861-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220343802084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care