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:
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Health care specialties

SpecialtyCodeLicense #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 6 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 1013040666 NPPES
North Carolina MEDICAID 5907566
North Carolina Other 200401063

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