Provider Demographics
NPI:1467605188
Name:MABRY, SHARISSA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARISSA
Middle Name:BETH
Last Name:MABRY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7301 MISSION RD STE 350
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3075
Mailing Address - Country:US
Mailing Address - Phone:913-945-9680
Mailing Address - Fax:913-945-9681
Practice Address - Street 1:7301 MISSION RD STE 350
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3075
Practice Address - Country:US
Practice Address - Phone:913-945-9680
Practice Address - Fax:913-945-9681
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY250857207Q00000X
KS04-39745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY250857OtherLICENSE #
NJ25MA09144300OtherMEDICAL LICENSE