Healthcare Provider Details

I. General information

NPI: 1457171308
Provider Name (Legal Business Name): SHADAE CARR CD,PCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N LAWNDALE AVE
KANSAS CITY MO
64123-1412
US

IV. Provider business mailing address

7736 W 95TH ST APT D
OVERLAND PARK KS
66212-6120
US

V. Phone/Fax

Practice location:
  • Phone: 816-859-9976
  • Fax:
Mailing address:
  • Phone: 816-859-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: