Provider Demographics
NPI:1184985921
Name:RIPLEY, SHANNA ROSE (DO)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:ROSE
Last Name:RIPLEY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:ROSE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:407-533-6836
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:1513 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2538
Practice Address - Country:US
Practice Address - Phone:816-731-1890
Practice Address - Fax:833-996-1159
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015007393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine