Wallace, Shana Dale
Wallace, Shana Dale is an individual health care provider with primary practice located at 1900 Randolph Rd Suite 1010, Charlotte NC 28207-1122. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurodevelopmental Disabilities, Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology. Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology is her primary health care specialty. Wallace, Shana Dale can be contacted via phone (704) 384-1390.Contact Information
Primary practice address
1900 Randolph Rd Suite 1010
Charlotte NC 28207-1122
Phone: (704) 384-1390
Fax: (704) 384-1063
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurodevelopmental Disabilities | 2080P0008X | 2004-01063 | North Carolina |
| Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology | 2084N0402X | 200401063 | North Carolina |
Profile Details
| NPI number | 1013040666 |
|---|---|
| LBN Legal business name | Wallace, Shana Dale |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 13th, 2007 |
| Last updated | Oct 25th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013040666 | NPPES |
| North Carolina | MEDICAID | 5907566 | |
| North Carolina | Other | 200401063 |
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