Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Shana Dale Wallace, MD

Individual provider Pediatric Neurodevelopmental Disabilities Physician · NPI 1013040666

Dr. Shana Dale Wallace, MD is a Neurology in Charlotte, North Carolina. Qualified in 2002, 24 years ago. Practices with Novant Health Medical Group, LLC, a 2,410-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
24
Licensed in
NC
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1900 Randolph Rd Ste 1010
Charlotte, NC 28207-1122
Phone: (704) 384-1390
Fax: (704) 384-1063
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neurology with Special Qualifications in Child Neurology Physician (primary) Taxonomy 2084N0402X · Licence 200401063 (NC)
Pediatric Neurodevelopmental Disabilities Physician Taxonomy 2080P0008X · Licence 2004-01063 (NC)

Record details

NPI number1013040666
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 13, 2007
Last updated in NPPESOctober 25, 2020
Certification dateSeptember 6, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEUROLOGY
Also practisesPEDIATRIC MEDICINE
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Novant Health Medical Group, Llc — 2410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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