Provider Demographics
NPI:1639140288
Name:GUPTA-BURT, SHALINA D (MD)
Entity Type:Individual
Prefix:
First Name:SHALINA
Middle Name:D
Last Name:GUPTA-BURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHALINA
Other - Middle Name:D
Other - Last Name:BURT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11300 CORPORATE AVE
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1374
Mailing Address - Country:US
Mailing Address - Phone:913-574-2800
Mailing Address - Fax:913-574-2336
Practice Address - Street 1:2750 CLAY EDWARDS DR LOWR LEVEL010
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-691-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30933207RX0202X, 2085R0001X
MO20040255112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209412303Medicaid
KS200277910IMedicaid
KS200277910CMedicaid
KS200277910HMedicaid