Provider Demographics
NPI:1649500463
Name:GORDON-ROBINSON, SHALANDA NICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHALANDA
Middle Name:NICHELLE
Last Name:GORDON-ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 MCDERMOTT RD STE 220
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7767
Mailing Address - Country:US
Mailing Address - Phone:214-396-9699
Mailing Address - Fax:844-895-4585
Practice Address - Street 1:5200 MCDERMOTT RD STE 220
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7767
Practice Address - Country:US
Practice Address - Phone:214-396-9699
Practice Address - Fax:844-895-4585
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34687103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB165643Medicare PIN