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Dr. Shana Dale Wallace, MD
Neurology with Special Qualifications in Child Neurology Physician in Charlotte, North Carolina
NPI 1013040666

Shana Dale Wallace is a Neurology with Special Qualifications in Child Neurology Physician based in Charlotte, NC and is specialized in Neurology with Special Qualifications in Child Neurology. Shana Dale Wallace practices in Charlotte, NC and has the professional credentials of MD. The NPI Number for Shana Dale Wallace is 1013040666 and holds a License No. 2004-01063 (North Carolina).

The current practice location address for Shana Dale Wallace is 1900 Randolph Rd, Charlotte, NC and can be reached out via phone at 704-384-1390 and via fax at 704-384-1063.

Location: 1900 Randolph Rd, Charlotte, NC, 28260-0447
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1013040666
Provider Name
Shana Dale Wallace
Credential
MD
Provider Entity Type
Individual
Gender
Female
Address
1900 Randolph Rd, Charlotte, NC, 28260-0447
Phone Number
704-384-1390
Fax Number
704-384-1063
Provider Enumeration Date
03/13/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
5907566 05 NC
200401063 01 NC MEDICAL LICENSE
institution
Provider Business Practice Location Address Details
Address
1900 Randolph Rd
City
Charlotte
State
North Carolina
Zip
28207-1122
Phone Number
704-384-1390
Fax Number
704-384-1063
person
Provider Business Mailing Address Details
Address
1900 Randolph Rd
City
Charlotte
State
North Carolina
Zip
28207-1122
Phone Number
704-384-1390
Fax Number
704-384-1063
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Pediatrics
Speciality
Neurodevelopmental Disabilities
Taxonomy
2080P0008X
License No.
200401063 (North Carolina)
Definition
A pediatrician who treats children having developmental delays or learning disorders including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism and other chronic neurologic conditions. This specialist provides medical consultation and education and assumes leadership in the interdisciplinary management of children with neurodevelopmental disorders. They may also focus on the early identification and diagnosis of neurodevelopmental disabilities in infants and young children as well as on changes that occur as the child with developmental disabilities grows.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Psychiatry & Neurology
Speciality
Neurology with Special Qualifications in Child Neurology
Taxonomy
2084N0402X
License No.
2004-01063 (North Carolina)
Definition
A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.
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