Provider Demographics
NPI:1902821051
Name:SHELLHAAS, RENEE ADELE (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:ADELE
Last Name:SHELLHAAS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:314-454-6120
Mailing Address - Fax:314-454-2523
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DEPT NEUROLOGY, STE 2130
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6120
Practice Address - Fax:314-454-2523
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220489962084N0402X, 2084E0001X
PAMD4219372084N0400X, 2084N0402X
MI43010899542084N0402X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200118772Medicaid