Provider Demographics
NPI:1568220127
Name:JAVED, NISMA (MBBS)
Entity Type:Individual
Prefix:
First Name:NISMA
Middle Name:
Last Name:JAVED
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 S SPRING AVE
Mailing Address - Street 2:SLUCARE ACADEMIC PAVILION
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-617-3137
Mailing Address - Fax:314-977-3127
Practice Address - Street 1:1201 S GRAND BLVD
Practice Address - Street 2:SSM SAINT LOUIS UNIVERSITY HOSPITAL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-617-2355
Practice Address - Fax:314-768-6616
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program