Provider Demographics
NPI:1467545863
Name:GRAY, SHALAUNDA K (MD)
Entity Type:Individual
Prefix:DR
First Name:SHALAUNDA
Middle Name:K
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 E 40 HWY STE H
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5954
Mailing Address - Country:US
Mailing Address - Phone:816-690-5700
Mailing Address - Fax:816-708-0772
Practice Address - Street 1:12410 E 40 HWY STE H
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5954
Practice Address - Country:US
Practice Address - Phone:816-690-5700
Practice Address - Fax:816-708-0772
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430824207Q00000X
MO2009020484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200266760HMedicaid
34398046OtherBCBS OF KANSAS CITY
I17455Medicare UPIN
KS130758002Medicare PIN