Provider Demographics
NPI:1477634764
Name:COHEN, SHARI D (MD)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:D
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6825
Mailing Address - Country:US
Mailing Address - Phone:314-872-8822
Mailing Address - Fax:314-432-2331
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-872-8822
Practice Address - Fax:314-432-2331
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7H85207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5018OtherBNDD
MO203350723Medicaid
MOR7H85OtherMEDICAL LICENSE
MOR7H85OtherMEDICAL LICENSE
MOBD1425962OtherDEA
5018OtherBNDD