Healthcare Provider Details

I. General information

NPI: 1083822365
Provider Name (Legal Business Name): SHELLY BUEHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

IV. Provider business mailing address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000124
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: