Provider Demographics
NPI:1912961145
Name:HALL, SHELLEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 WORTH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2057
Mailing Address - Country:US
Mailing Address - Phone:214-841-2000
Mailing Address - Fax:844-292-1458
Practice Address - Street 1:3409 WORTH ST STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2057
Practice Address - Country:US
Practice Address - Phone:214-841-2000
Practice Address - Fax:214-841-2015
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2047207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123575605Medicaid
TX85G131OtherBCBS
TX123575604Medicaid
TX123575601Medicaid
TX123575604Medicaid
TXTXB135391Medicare PIN
TX85G131Medicare PIN