Basic Information
Provider Information
NPI: 1184973075
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MASSAY
FirstName: AAMER
MiddleName: SHERAZ
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12125 WOODCREST EXECUTIVE DR
Address2: SUITE 220
City: SAINT LOUIS
State: MO
PostalCode: 631415001
CountryCode: US
TelephoneNumber: 3143170600
FaxNumber: 3143170606
Practice Location
Address1: 10010 KENNERLY RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631282106
CountryCode: US
TelephoneNumber: 3143170600
FaxNumber: 3143170606
Other Information
ProviderEnumerationDate: 09/06/2012
LastUpdateDate: 08/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X2012015127MOY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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