Basic Information
| Provider Information | |||||||||
| NPI: | 1467545863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | SHALAUNDA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 12410 E 40 HWY STE H | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640555954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166905700 | ||||||||
| FaxNumber: | 8167080772 | ||||||||
| Practice Location | |||||||||
| Address1: | 12410 E 40 HWY STE H | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640555954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166905700 | ||||||||
| FaxNumber: | 8167080772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2006 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0430824 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2009020484 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200266760H | 05 | KS | MEDICAID | 34398046 | 01 | BCBS OF KANSAS CITY | OTHER |