A unified design sensitivity analysis method for a meshfree shell structure with respect to sizing, shape, and configuration design variables is presented in this paper. A shear deformable shell formulation is characterized by a CAD connection, thickness degeneration, meshfree discretization, and nodal integration. The design variable is selected from the CAD parameters, and a consistent design velocity field is then computed by perturbing the surface geometric matrix. The material derivative concept is used to obtain a design sensitivity equation in the parametric domain. Numerical examples show the accuracy and efficiency of the proposed design sensitivity analysis method compared to the analytical solution and the finite difference solution.