Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2003001990 | MO |
N | 2080P0006X | Developmental - Behavioral Pediatrician | 2003001990 | MO |
Y | 2084N0402X | Child Neurologist | 2003001990 | MO |
NPI | 1033115589 |
---|---|
Provider Name | Shulamit Menashe Portnoy |
First Address | Saint Louis, MO 63150-3900 |
Second Address | St. Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 11/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208419606 | (05) | MO |
H86335 | (02) | MO |