Provider Demographics
NPI:1063956084
Name:BRENSON, SHONTA
Entity type:Individual
Prefix:
First Name:SHONTA
Middle Name:
Last Name:BRENSON
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 1:10001 E 67TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-5218
Mailing Address - Country:US
Mailing Address - Phone:816-616-8060
Mailing Address - Fax:816-494-2708
Practice Address - Street 1:10001 E 67TH ST STE 101
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-5218
Practice Address - Country:US
Practice Address - Phone:816-616-8060
Practice Address - Fax:816-494-2708
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO246RP1900X246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy