Provider Demographics
NPI:1861838559
Name:DELONG, SHELLEY HAGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:HAGAN
Last Name:DELONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:HAGAN
Other - Last Name:BRIDGFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 11157
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-0157
Mailing Address - Country:US
Mailing Address - Phone:816-346-7220
Mailing Address - Fax:816-346-7242
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-691-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020992207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1861838559Medicaid
MO1861838559Medicaid