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

Individual provider Athletic Trainer · NPI 1710524913

Shyann Wallace, ATC, LAT is an Athletic Trainer in Lebanon, Pennsylvania. Practices as a sole proprietor. Licensed in Pennsylvania.

Licensed in
PA
In the registry since
2019
Specialties on file
2
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.
LAT — Licensed Athletic Trainer
A state-licensed athletic trainer.

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Practice location Address checks out

1150 Harvest Dr
Lebanon, PA 17046-1574
Phone: (717) 376-9110
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence RTO000512 (PA)
Athletic Trainer Taxonomy 2255A2300X

Record details

NPI number1710524913
Entity typeIndividual (Type 1)
GenderFemale
Credentials ATC , LAT
Sole proprietorYes
NPI enumeratedDecember 6, 2019
Last updated in NPPESJanuary 11, 2021
Certification dateJanuary 11, 2021

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