Provider Demographics
NPI:1518318567
Name:SOOMRO, AYESHA (MD)
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:
Last Name:SOOMRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD STE 295B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2177
Mailing Address - Country:US
Mailing Address - Phone:314-740-2949
Mailing Address - Fax:314-375-5020
Practice Address - Street 1:10004 KENNERLY RD STE 295B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2177
Practice Address - Country:US
Practice Address - Phone:314-740-2949
Practice Address - Fax:314-375-5020
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019024581207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine