Individual
DR. KELLEY SHIELDS CADDEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11642 W FLORISSANT AVE, FLORISSANT, MO 63033-6723
(314) 838-8220
Mailing address
11642 W FLORISSANT AVE, FLORISSANT, MO 63033-6723
(314) 838-8220
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2008015402
MO
208000000X
Pediatrics Physician
Primary
2012003226
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012003226
STATE LICENSE
MO
Enumeration date
07/17/2008
Last updated
02/26/2024
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