Healthcare Provider Details

I. General information

NPI: 1609368117
Provider Name (Legal Business Name): SHALANDA HALL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 W HIGHWAY 74 STE K
MONROE NC
28110-8695
US

IV. Provider business mailing address

PO BOX 25
MARSHVILLE NC
28103-0025
US

V. Phone/Fax

Practice location:
  • Phone: 704-624-7090
  • Fax: 704-624-7029
Mailing address:
  • Phone: 704-624-7090
  • Fax: 704-624-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number734
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number734
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number734
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: