Individual
SANDY MARIE THAKADIYIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8277
(314) 251-5860
Mailing address
12405 BUR OAK DR, SAINT LOUIS, MO 63146-3082
(630) 740-5101
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036137325
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
2018033141
MO
Other
Enumeration date
04/21/2015
Last updated
09/25/2024
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