Provider Demographics
NPI:1710009774
Name:SULLIVANT, SHAYLA ANN (MD)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:ANN
Last Name:SULLIVANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:ANN
Other - Last Name:SULLIVANT DEHAEMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3674
Mailing Address - Fax:816-346-1382
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3674
Practice Address - Fax:816-346-1382
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100282992084P0804X
KS94063872084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry