Healthcare Provider Details

I. General information

NPI: 1407762990
Provider Name (Legal Business Name): SHELBY MCLEOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BECKER DR
LAWRENCE KS
66047-1620
US

IV. Provider business mailing address

522 S CHERRY ST
OLATHE KS
66061-4502
US

V. Phone/Fax

Practice location:
  • Phone: 816-382-7246
  • Fax:
Mailing address:
  • Phone: 816-382-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3-123454
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: