Healthcare Provider Details

I. General information

NPI: 1356698963
Provider Name (Legal Business Name): SHARON KAY DEMOSS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 N OAK TRFY
KANSAS CITY MO
64155-2233
US

IV. Provider business mailing address

9405 N OAK TRFY
KANSAS CITY MO
64155-2233
US

V. Phone/Fax

Practice location:
  • Phone: 816-412-2900
  • Fax: 816-412-2915
Mailing address:
  • Phone: 816-412-2900
  • Fax: 816-412-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11172571
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: