Provider Demographics
NPI:1326530577
Name:ASTANI, SAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMA
Middle Name:
Last Name:ASTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6120
Mailing Address - Fax:314-454-4225
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DEPT NEUROLOGY, STE 2130
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6120
Practice Address - Fax:314-454-4225
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220162552084N0400X
TXU98242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200110633Medicaid