Khushboo Jitendra Sadadiwala, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

00015546 Issued in CO

Practice address

11358 Van Cleve Ave
Saint Louis, MO 63114-1131

Phone

(314) 968-2350

NPI assigned

Aug 28, 2024

Last updated

Aug 28, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Children's Home Society of Missouri

  dba FamilyForward

  • Clinic/Center
  • Saint Louis, MO
  • NPI 1134244353
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1285468603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 S BRENTWOOD BLVD APT 121",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631441837",
            "telephone_number": "267-357-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11358 VAN CLEVE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631141131",
            "telephone_number": "314-968-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADADIWALA",
        "first_name": "KHUSHBOO",
        "middle_name": "JITENDRA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "00015546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aldijana Sacic
• Gregory William Sack
• Bethany C Sacks, MD
• Justin M Sacks, MD
• Sacred Hands LLC
• Farid G. Sadaka, M.D.
• Tiare Sadarananda, OTR/L
• Saddler Group Adult Day Care
• Saddler Residential Care Facility, Inc.
• Laterryl Saddler

• Psychologist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.