Provider Demographics
NPI:1285689471
Name:SHASHEK, JENNIFER L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:SHASHEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 HERITAGE LANDING, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-8448
Mailing Address - Country:US
Mailing Address - Phone:636-248-6294
Mailing Address - Fax:636-317-1080
Practice Address - Street 1:1600 HERITAGE LANDING, SUITE 201
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-8448
Practice Address - Country:US
Practice Address - Phone:636-248-6294
Practice Address - Fax:636-317-1080
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361147572084P0800X
MO20020102662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
156881Medicare UPIN