NPI 1013040666

Shana Dale Wallace, MD

Practitioner Neurology with Special Qualifications in Child Neurology Physician Charlotte, NC

Practice location

Address: 1900 Randolph Rd Suite 1010, Charlotte, NC 28207-1122
Phone: (704) 384-1390
Fax: (704) 384-1063
Mailing address: PO Box 60447, Charlotte, NC 28260-0447

Registered specialties (2)

Neurology with Special Qualifications in Child Neurology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2084N0402X Licence 200401063 (NC)

Other Psychiatry & Neurology providers in North Carolina →

Pediatric Neurodevelopmental Disabilities Physician

Allopathic & Osteopathic Physicians Taxonomy 2080P0008X Licence 2004-01063 (NC)

Other Pediatrics providers in North Carolina →

Registry record

NPI: 1013040666
Entity type: Individual
Sex (as registered): Female
NPI issued: 13 Mar 2007
Record last updated: 25 Oct 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.