Healthcare Provider Details

I. General information

NPI: 1912961145
Provider Name (Legal Business Name): SHELLEY A HALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 WORTH ST STE 500
DALLAS TX
75246-2057
US

IV. Provider business mailing address

3409 WORTH ST STE 500
DALLAS TX
75246-2057
US

V. Phone/Fax

Practice location:
  • Phone: 214-841-2000
  • Fax: 214-841-2015
Mailing address:
  • Phone: 214-841-2000
  • Fax: 844-292-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberJ2047
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberJ2047
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: