Provider Demographics
NPI:1639284276
Name:AJANEE, NADYA A (MD)
Entity type:Individual
Prefix:DR
First Name:NADYA
Middle Name:A
Last Name:AJANEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:STE 650N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-682-3625
Mailing Address - Fax:314-590-5953
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:STE 650N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-682-3625
Practice Address - Fax:314-590-5953
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005006925207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
841682728OtherTAX ID
P00259468OtherRR MEDICARE
MO206221400Medicaid
MOMA4945001Medicare PIN
014014694Medicare PIN
841682728OtherTAX ID
MO206221400Medicaid