Healthcare Provider Details

I. General information

NPI: 1639140288
Provider Name (Legal Business Name): SHALINA D. GUPTA-BURT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHALINA D. BURT M.D.

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 CLAY EDWARDS DR LOWR LEVEL010
NORTH KANSAS CITY MO
64116-3237
US

IV. Provider business mailing address

11300 CORPORATE AVE
LENEXA KS
66219-1374
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-5216
  • Fax:
Mailing address:
  • Phone: 913-574-2800
  • Fax: 913-574-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number04-30933
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number04-30933
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2004025511
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: