1861838559 NPI number — DR. SHELLEY HAGAN DELONG M.D.

Table of content: DR. SHELLEY HAGAN DELONG M.D. (NPI 1861838559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861838559 NPI number — DR. SHELLEY HAGAN DELONG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELONG
Provider First Name:
SHELLEY
Provider Middle Name:
HAGAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRIDGFORD
Provider Other First Name:
SHELLEY
Provider Other Middle Name:
HAGAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861838559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64119-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-346-7220
Provider Business Mailing Address Fax Number:
816-346-7242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-691-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  2015020992 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1861838559 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".