Provider Demographics
NPI:1922695493
Name:SAULSBERRY, SHANISHA LARIE
Entity Type:Individual
Prefix:
First Name:SHANISHA
Middle Name:LARIE
Last Name:SAULSBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 E 81ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-2337
Mailing Address - Country:US
Mailing Address - Phone:816-289-3425
Mailing Address - Fax:
Practice Address - Street 1:3825 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3344
Practice Address - Country:US
Practice Address - Phone:816-254-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001027481163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse