1. Home
  2. Directory
  3. North Carolina
  4. Charlotte
  5. Psychiatry Neurology
  6. NPI Profile

DR. SHANA DALE WALLACE MD
NPI 1013040666
Psychiatry & Neurology - Neurology with Special Qualifications in Child Neurology in Charlotte, NC

Active since March 13, 2007PECOS EnrolledAccepts Medicare Assignment
1900 RANDOLPH RD, SUITE 1010, CHARLOTTE, NC 28207(704) 384-1390(704) 384-1063 Get Directions Write a Review

NPPES record last updated: October 25, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Shana Dale Wallace Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHANA DALE WALLACE MD (NPI 1013040666) is an individual neurology with special qualifications in child neurology provider in Charlotte, North Carolina, licensed in North Carolina (200401063) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS and is a graduate of Other (2002).

NPPES Registry Identity

NPI1013040666
Entity TypeIndividualFemale
Primary Taxonomy2084N0402X
Provider Legal NameDR. SHANA DALE WALLACECredential: MD
Location Address1900 RANDOLPH RD, SUITE 1010Charlotte, NC 28207-1122
Mailing AddressPo Box 60447Charlotte, NC 28260-0447 · (704) 384-1390 · Fax (704) 384-1063
Phone(704) 384-1390
Fax(704) 384-1063
Sole ProprietorNo
Medical School CMSOtherGraduated 2002
Enumeration DateMarch 13, 2007
Last NPPES UpdateOctober 25, 2020
NPPES CertifiedSeptember 6, 2020
✔ NPI 1013040666 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · Neurology with Special Qualifications in Child NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0402X
License✔ Licensed in NC · 200401063
Definition
A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.
Also ListedPediatrics · Neurodevelopmental DisabilitiesTaxonomy 2080P0008X · License 2004-01063 (NC)
1900 RANDOLPH RD, Charlotte, NC 28207
Open in Google Maps ↗

Other Names 1

Former Name (1)Dr. Shana Dale Green Md

Other Identifiers 2

Medicaid5907566NC
Other200401063NC · Medical License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Shana Dale Wallace Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4880832401
PECOS Enrollment IDI20180927000218
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 28207 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$125.01 typical visit price
range $54.12 – $165.09
Typical copayment $31.25 (range $13.53 – $41.27)
Most-billed visit code 99204
Established Patient
$95.94 typical visit price
range $17.21 – $134.61
Typical copayment $23.98 (range $4.30 – $33.65)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NOVANT HEALTH MEDICAL GROUP, LLC
Internal Medicine (Infectious Disease)
1900 RANDOLPH RD, SUITE 216
CHARLOTTE, NC 28207
Mecklenburg County (704) 384-5416
JOHN B CLARK JR. M.D.
Emergency Medicine
1900 RANDOLPH RD, STE 900
CHARLOTTE, NC 28207
Mecklenburg County (704) 377-2424
SACHIN JAMNADAS HANSALIA M.D.
Internal Medicine (Critical Care Medicine)
1900 RANDOLPH RD, SUITE 580
CHARLOTTE, NC 28207
Mecklenburg County (704) 384-9900
JAMES E PUGH MD
Psychiatry & Neurology (Neurology)
1900 RANDOLPH RD, SUITE 1010
CHARLOTTE, NC 28207
Mecklenburg County (704) 334-7311
DONALD P. RUSH LCSW
Social Worker (Clinical)
1900 RANDOLPH RD, SUITE 800
CHARLOTTE, NC 28207
Mecklenburg County (704) 384-1246
EDWIN T HOLLOWAY M.D.
Emergency Medicine
1900 RANDOLPH RD, STE 900
CHARLOTTE, NC 28207
Mecklenburg County (704) 377-2424
JOHN W RINGWOOD M.D.
Emergency Medicine (Pediatric Emergency Medicine)
1900 RANDOLPH RD, STE 900
CHARLOTTE, NC 28207
Mecklenburg County (704) 377-2424
ROBERT JOSEPH ATTORRI M.D.
Surgery
1900 RANDOLPH RD, STE 210
CHARLOTTE, NC 28207
Mecklenburg County (704) 370-0223

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shana Wallace's NPI number?

The NPI number for Shana Wallace is 1013040666. It was assigned to this individual provider in the NPPES registry on March 13, 2007. The provider is also known as Dr. Shana Dale Green MD.

Where is Shana Wallace located?

Shana Wallace practices at 1900 Randolph Rd Suite 1010, Charlotte, NC 28207. The listed phone number is (704) 384-1390.

What is Shana Wallace's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology with Special Qualifications in Child Neurology, with taxonomy code 2084N0402X.

Is Shana Wallace enrolled in Medicare?

Yes. Shana Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Shana Wallace accept?

Health plans from Blue Cross and Blue Shield of NC list Shana Wallace as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shana Wallace was last updated on October 25, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.