Healthcare Provider Details

I. General information

NPI: 1417696345
Provider Name (Legal Business Name): SHALVA ELIAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date: 02/27/2023
Reactivation Date: 03/08/2023

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

350 ENGLE STREET, DEPARTMENT OF MEDICINE
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 201-894-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-53153
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number04-53153
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: