Provider Demographics
NPI:1609368117
Name:HALL, SHALANDA LATRICE (DPM)
Entity Type:Individual
Prefix:
First Name:SHALANDA
Middle Name:LATRICE
Last Name:HALL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 REGIONAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9868
Mailing Address - Country:US
Mailing Address - Phone:910-295-9255
Mailing Address - Fax:910-295-7255
Practice Address - Street 1:6 REGIONAL DR STE D
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9868
Practice Address - Country:US
Practice Address - Phone:910-295-9255
Practice Address - Fax:910-295-7255
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC734213ES0103X, 213ES0131X, 213EP1101X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program