Dr. Shana Dale Wallace
Child Neurologist
1900 Randolph Rd Suite 1010
Charlotte
, North Carolina 28207-1122
Dr. Shana Dale Wallace
Child Neurologist
1900 Randolph Rd Suite 1010
Charlotte
, North Carolina 28207-1122
(704) 384-1063
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About
Features
Specialties
- Child Neurologist
Languages spoken
- English
Location
First Address
- Dr. Shana Dale Wallace
- Po Box 60447
- Charlotte, NC
- Zip : 28260-0447
- Fax : (704) 384-1063
- Phone : (704) 384-1390
Second Address
- Dr. Shana Dale Wallace
- 1900 Randolph Rd Suite 1010
- Charlotte, NC
- Zip : 28207-1122
- Fax : (704) 384-1063
- Phone : (704) 384-1390
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2084N0402X | Child Neurologist | 200401063 | NC |
National Provider Identifier
| NPI | 1013040666 |
|---|---|
| Provider Name | Dr. Shana Dale Wallace |
| First Address | Charlotte, NC 28260-0447 |
| Second Address | Charlotte, NC 28207-1122 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/03/2007 |
| Last Update Date | 25/10/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 200401063 | MEDICAL LICENSE (01) | NC |
| 5907566 | (05) | NC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.