Provider Demographics
NPI:1891808051
Name:BHATTACHARYA, SHELLEY B (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:B
Last Name:BHATTACHARYA
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:B
Other - Last Name:BANERJEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, MPH
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-1944
Mailing Address - Fax:913-588-2496
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 4017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-1944
Practice Address - Fax:913-588-2496
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0531480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
35853013OtherBCBS OF KANSAS CITY
KS927660OtherFIRSTGUARD
KS200334220AMedicaid
P00268409OtherRAILROAD MEDICARE
KS927660OtherFIRSTGUARD
229E052AMedicare ID - Type Unspecified