Provider Demographics
NPI:1356428346
Name:BHUYAN, ELLY (MD)
Entity type:Individual
Prefix:DR
First Name:ELLY
Middle Name:
Last Name:BHUYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:443 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 249
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6800
Mailing Address - Country:US
Mailing Address - Phone:314-872-7069
Mailing Address - Fax:314-872-9103
Practice Address - Street 1:443 N NEW BALLAS RD
Practice Address - Street 2:SUITE 249
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6800
Practice Address - Country:US
Practice Address - Phone:314-872-7069
Practice Address - Fax:314-872-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR81532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11484Medicare UPIN
MO623004266Medicare ID - Type Unspecified