Provider Demographics
NPI:1609368117
Name:HALL, SHALANDA LATRICE (DPM)
Entity type:Individual
Prefix:
First Name:SHALANDA
Middle Name:LATRICE
Last Name:HALL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-1142
Mailing Address - Country:US
Mailing Address - Phone:704-624-7090
Mailing Address - Fax:704-624-7029
Practice Address - Street 1:119 E UNION ST
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1142
Practice Address - Country:US
Practice Address - Phone:704-624-7090
Practice Address - Fax:704-624-7029
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC734213ES0103X, 213ES0131X, 213EP1101X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery