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

Shannon Wallace

Individual provider Specialist · NPI 1588142574

Shannon Wallace is a Specialist in Bellerose, New York. Registered with an NPI since 2018.

In the registry since
2018
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Practice location Address checks out

8777 254th St
Bellerose, NY 11426-2329
Phone: (347) 324-2766
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X

Record details

NPI number1588142574
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 1, 2018
Last updated in NPPESSeptember 13, 2018

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