Healthcare Provider Details

I. General information

NPI: 1245846419
Provider Name (Legal Business Name): DANIELLE M. SHANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6923 SHANNON WILLOW RD STE 100
CHARLOTTE NC
28226-1331
US

IV. Provider business mailing address

114 GREENHILL LN
MOORESVILLE NC
28117-5950
US

V. Phone/Fax

Practice location:
  • Phone: 980-237-3132
  • Fax:
Mailing address:
  • Phone: 704-929-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15022
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: