Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 2007-00714 | NC |
NPI | 1033222864 |
---|---|
Provider Name | Amanda Dale-Shall |
First Address | Charlotte, NC 28203-5866 |
Second Address | Charlotte, NC 28203-5866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 12/02/2019 |