Healthcare Provider Details

I. General information

NPI: 1649500463
Provider Name (Legal Business Name): SHALANDA NICHELLE GORDON-ROBINSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 MCDERMOTT RD STE 220
PLANO TX
75024-7767
US

IV. Provider business mailing address

5200 MCDERMOTT RD STE 220
PLANO TX
75024-7767
US

V. Phone/Fax

Practice location:
  • Phone: 214-396-9699
  • Fax: 844-895-4585
Mailing address:
  • Phone: 214-396-9699
  • Fax: 844-895-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number34687
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34687
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: