Provider Demographics
NPI:1851782890
Name:SHAH, MEGAN DIANE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DIANE
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:ECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:4320 WORNALL RD STE 50
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5943
Mailing Address - Country:US
Mailing Address - Phone:816-931-3312
Mailing Address - Fax:816-889-1584
Practice Address - Street 1:4320 WORNALL RD STE 50
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5943
Practice Address - Country:US
Practice Address - Phone:816-931-3312
Practice Address - Fax:816-889-1584
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012003460363AS0400X
MO2015003460363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical