Provider Demographics
NPI:1891081055
Name:RAY, SHUDDHADEB (MD)
Entity type:Individual
Prefix:DR
First Name:SHUDDHADEB
Middle Name:
Last Name:RAY
Suffix:
Gender:
Credentials:MD
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 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-355-3003
Mailing Address - Fax:314-355-0515
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:DIV SURG CT ADULT CARDIO, STE 209E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-355-3003
Practice Address - Fax:314-355-0515
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013032978208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200071144Medicaid