Provider Demographics
NPI:1881085066
Name:SHANDLEY, AUSTIN (PA)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:SHANDLEY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2459
Mailing Address - Country:US
Mailing Address - Phone:816-364-1507
Mailing Address - Fax:
Practice Address - Street 1:8656 N AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2558
Practice Address - Country:US
Practice Address - Phone:816-584-8100
Practice Address - Fax:816-584-8106
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00000000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant