Provider Demographics
NPI:1144486580
Name:WALL, SHELLEY (SA-C)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-5240
Mailing Address - Country:US
Mailing Address - Phone:615-948-3492
Mailing Address - Fax:
Practice Address - Street 1:312 21ST AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-0001
Practice Address - Country:US
Practice Address - Phone:615-321-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant