Provider Demographics
NPI:1740488444
Name:BELLARD, SHAILAJA ATHOTA (MD)
Entity type:Individual
Prefix:
First Name:SHAILAJA
Middle Name:ATHOTA
Last Name:BELLARD
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 1:351 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-200-4242
Mailing Address - Fax:636-200-4243
Practice Address - Street 1:17050 BAXTER RD STE 110
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1422
Practice Address - Country:US
Practice Address - Phone:636-200-4242
Practice Address - Fax:636-200-4243
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018691390200000X
MO2010018424207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program