SHULAMIT MENASHE PORTNOY (NPI# 1033115589) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033115589 |
| Entity Type | Individual |
| Full Name | SHULAMIT MENASHE PORTNOY |
| Credential | MD |
| Practice Address |
1465 S Grand Blvd St. Louis MO 63104-1003 |
| Mailing Address |
Po Box 503900 Saint Louis MO 63150-3900 |
| Practice Telephone | 3145775609 |
| Practice Fax Number | 3142684028 |
| Mailing Telephone | 3145775609 |
| Mailing Fax Number | 3142684028 |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2019-09-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 2003001990 | MO | Allopathic & Osteopathic Physicians |
| N | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
2003001990 | MO | Allopathic & Osteopathic Physicians |
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
2003001990 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 208419606 | 05 |
| Street Address |
1465 S GRAND BLVD |
| City | ST. LOUIS |
| State | MO |
| Zip Code | 63104-1003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982959433 | Anya Jennifer Freedman | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2012-07-20 |
| 1508125295 | Neal Russell Hartman | Emergency Medicine | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2012-05-15 |
| 1275820359 | Joseph George Maliakkal | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2011-07-08 |
| 1043500416 | Lauren Rhae Draper | Pediatrics | 1465 S Grand Blvd, Department of Pediatrics Division of Heme/onc, St. Louis, MO 63104 | 2011-04-19 |
| 1043500507 | Debra H Zand | Psychologist | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2011-04-18 |
| 1548569734 | Elisa Rachel Pincus | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2011-03-28 |
| 1265747596 | Dhiren Ranchhodbhai Patel | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2010-08-11 |
| 1346404191 | Justin B Josephsen | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2008-07-10 |
| 1043471477 | Rocio Del Carmen Zeballos-chavez | Internal Medicine | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2008-06-18 |
| 1013195122 | Margaret Kathleen Siska | Pediatrics | 1465 S Grand Blvd, St. Louis, MO 63104-1003 | 2008-01-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407469570 | Family Care Health Centers | Clinic/Center | 2717 Sidney Street, St. Louis, MO 63104 | 2020-08-28 |
| 1023638038 | Laura Ann Humphrey | Physician Assistant | Allied Health Building 3437 Caroline Street, Room 3015, Saint Louis, MO 63104 | 2020-04-20 |
| 1174187264 | Ahsan Ali | Student in an Organized Health Care Education/Training Program | 1438 South Grand Blvd, Monteleone Hall, St. Louis, MO 63104 | 2019-04-24 |
| 1205359916 | Brenda Eve Ladin | Behavior Technician | 1221 Allen Market Lane Rear, St. Louis, MO 63104 | 2017-07-25 |
| 1841722063 | Gustavo G Mendez | Student in an Organized Health Care Education/Training Program | 1465 South Grand Bulevard Rm 2717, Ssm Health Cardinal Glennon Children's Hospital, Saint Louis, MO 63104 | 2017-03-28 |
| 1053776716 | Carmella Harper | Respiratory Therapist, Certified | 2678 Park Ave, St Louis, MO 63104 | 2015-12-23 |
| 1922485986 | Alexander Tremont | Internal Medicine | 1402 S Grand Blvd Rm M260, Saint Louis, MO 63104 | 2015-04-29 |
| 1306233341 | Healthcare R Us | Home Health | 2859 Sidney St, St Louis, MO 63104 | 2015-04-16 |
| 1396159091 | Daniela Hermelin | Pathology | 1402 South Grane, St. Louis, MO 63104 | 2014-06-20 |
| 1992117881 | Kelly Denise Durbin | Social Worker | 1920 S 7th St, Saint Louis, MO 63104 | 2014-05-27 |
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| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780028043 | Lindsay Peglar | Psychiatry & Neurology | 1 Childrens Place, Suite 2d, St. Louis, MO 63110 | 2013-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356478705 | Robin Chanel Ryther | Psychiatry & Neurology | 1 Childrens Pl Ste D, Ste D, Saint Louis, MO 63110-1002 | 2007-02-27 |
| 1902992696 | David J Callahan | Psychiatry & Neurology | 13001 N Outer 40 Rd Ste 1a, Ste 1a, Chesterfield, MO 63017-5941 | 2006-10-04 |
| 1912986332 | Robert Gordon Mcafee | Psychiatry & Neurology | 600 N Main, Mount Vernon, MO 65712 | 2006-01-13 |
| 1538542329 | Benjamin Paul Kay | Psychiatry & Neurology | 1 Barnes Jewish Hospital Plz, 1st Fl, Pediatric Neurology, Saint Louis, MO 63110-1003 | 2015-06-30 |
| 1023499001 | Regina Lindsay Triplett | Psychiatry & Neurology | 1 Childrens Pl, 3s34, Saint Louis, MO 63110-1002 | 2015-06-15 |
| 1619382645 | Dusit Adstamongkonkul | Psychiatry & Neurology | 1000 E Primrose St Ste 200, Springfield, MO 65807 | 2014-06-28 |
| 1881034866 | Shannon Christine Agner | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2013-07-05 |
| 1497195960 | Oleg V Lobanov | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2013-06-28 |
| 1255776704 | Nitin C Patel Md LLC | Psychiatry & Neurology | 1100 Club Village Dr Ste 102, Columbia, MO 65203-4411 | 2013-05-09 |
| 1497199640 | Keisuke Ueda | Psychiatry & Neurology | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2013-04-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.