Provider Demographics
NPI:1720105281
Name:DUARTE-SCKELL, SANDRA D (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:DUARTE-SCKELL
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 1:1063 FRUIT TREE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4514
Mailing Address - Country:US
Mailing Address - Phone:314-898-8750
Mailing Address - Fax:
Practice Address - Street 1:3535 S JEFFERSON AVE STE 118
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3907
Practice Address - Country:US
Practice Address - Phone:314-776-7999
Practice Address - Fax:314-772-2257
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040180412084P0800X
CT0460682084P0800X
RIMD129642084P0800X
MO20100272612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISD75901Medicaid