Healthcare Provider Details

I. General information

NPI: 1871157552
Provider Name (Legal Business Name): SHELBY MASSEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11320 E TRUMAN RD
INDEPENDENCE MO
64050-2564
US

IV. Provider business mailing address

3801 DR MARTIN LUTHER KING JR BLVD
KANSAS CITY MO
64130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 816-599-5201
  • Fax: 816-599-5964
Mailing address:
  • Phone: 816-923-5800
  • Fax: 816-923-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number208D00000X
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: