Shamirra Wallace
Specialist/Technologist, Other, Surgical Technologist in Brentwood, TN. Individual provider (NPI-1).
NPI number1619783115
StatusActive
Last updated in NPPESDec 9, 2024
Details
- NPI
- 1619783115
- Entity type
- Individual (NPI-1)
- Name
- Shamirra Wallace
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 9, 2024
- Certification date
- Dec 9, 2024
- Last updated
- Dec 9, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246ZS0410X | Specialist/Technologist, Other, Surgical Technologist | – | – | Yes |
Practice location
3 Maryland Farms Ste 200Brentwood, TN 37027-5780
Phone 800-348-4565
Mailing address
3 Maryland Farms Ste 200Brentwood, TN 37027-5780
Phone 800-348-4565
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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