Provider Demographics
NPI:1902853732
Name:SHEIKH, SHABNAM NADIA (MD)
Entity Type:Individual
Prefix:
First Name:SHABNAM NADIA
Middle Name:
Last Name:SHEIKH
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 1:1069 DOUGHERTY LAKE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4931
Mailing Address - Country:US
Mailing Address - Phone:636-226-4200
Mailing Address - Fax:
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8000
Practice Address - Fax:314-768-8011
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004011410207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1902853732Medicaid
MO219060OtherBLUE SHIELD
MO200839702Medicaid
MOI19761Medicare UPIN
MO1902853732Medicaid
MO200839702Medicaid
MO922805198Medicare PIN