Individual
SHANNON MICHELLE ROOT BAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
12266 DE PAUL DR STE 205, BRIDGETON, MO 63044-2514
(314) 218-2300
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2020023147
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/24/2019
Last updated
03/06/2026
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