Provider Demographics
NPI:1962451369
Name:WILKERSON-AMENDELL, SHARON ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ROSE
Last Name:WILKERSON-AMENDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:ROSE
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Other 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:816-960-2859
Mailing Address - Fax:816-960-2655
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:816-960-2859
Practice Address - Fax:816-960-2855
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8H15208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202583902Medicaid
MO202583902Medicaid
MO2690419Medicare PIN