Wallace, Shannon

Wallace, Shannon is an individual health care provider with primary practice located at 8777 254Th St , Bellerose NY 11426-2329. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Wallace, Shannon can be contacted via phone (347) 324-2766.

Contact Information

Primary practice address
8777 254Th St Bellerose NY 11426-2329
Phone: (347) 324-2766
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X

Profile Details

NPI number 1588142574
LBN Legal business name Wallace, Shannon
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2018
Last updated Sep 13th, 2018 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588142574 NPPES
New York MEDICAID 0

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