Provider Demographics
NPI:1194384560
Name:DANIELS, CHELSEA LYN (DO)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LYN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:LYN
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 6017B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8274
Mailing Address - Country:US
Mailing Address - Phone:314-251-7840
Mailing Address - Fax:314-251-4173
Practice Address - Street 1:621 S NEW BALLAS RD STE 6017B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8274
Practice Address - Country:US
Practice Address - Phone:314-251-7840
Practice Address - Fax:314-251-4173
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022012999207Q00000X
MO2019019501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty