Individual
ELYSE A SHAW ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5643
(314) 268-4112
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5643
(314) 268-4112
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01078371
IN
208000000X
Pediatrics Physician
2018006628
MO
208M00000X
Hospitalist Physician
Primary
2018006628
MO
Other
Enumeration date
06/02/2014
Last updated
03/25/2025
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