Provider Demographics
NPI:1871795104
Name:SADIQ, SHEHLA (MD)
Entity type:Individual
Prefix:
First Name:SHEHLA
Middle Name:
Last Name:SADIQ
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 1:232 N KINGSHIGHWAY BLVD APT 618
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1248
Mailing Address - Country:US
Mailing Address - Phone:914-740-5481
Mailing Address - Fax:314-771-8575
Practice Address - Street 1:3660 VISTA AVE # 2104
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2540
Practice Address - Country:US
Practice Address - Phone:314-977-8462
Practice Address - Fax:314-771-8575
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2006021633207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine