Provider Demographics
NPI:1174789747
Name:WULFF, SHEPHALI HIMANSHU (DO)
Entity type:Individual
Prefix:DR
First Name:SHEPHALI
Middle Name:HIMANSHU
Last Name:WULFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504934
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4934
Mailing Address - Country:US
Mailing Address - Phone:773-272-2238
Mailing Address - Fax:
Practice Address - Street 1:330 1ST CAPITOL DR STE 260
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2888
Practice Address - Country:US
Practice Address - Phone:636-925-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051545207R00000X
MO2011011831207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOSTL79057906OtherMEDICARE ADVANTAGE