Shaunice Wall, DIETITIAN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI100000712 Issued in DC

Practice address

4 Atlantic St SW
Washington, DC 20032-2350

Phone

(202) 407-7747

Fax

(202) 232-8494

NPI assigned

Feb 10, 2020

Last updated

Feb 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1316579105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 ATLANTIC ST SW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200322350",
            "telephone_number": "202-407-7747",
            "fax_number": "202-232-8494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 ATLANTIC ST SW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200322350",
            "telephone_number": "202-407-7747",
            "fax_number": "202-232-8494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "SHAUNICE",
        "credential": "DIETITIAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "DC",
            "license": "DI100000712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Janel Wall, PSY.D
• Kristen Wall, FNP
• Latoya Wall
• Michael Wall
• Russell Wall
• Stephen Joseph Wall, M.D.,PH.D.
• Thomas M Wall, D.D.S., P.C.
• Colleen Michelle Wallace McKay, M.D.
• James Gavin Wallace-Mercado, DNP, MSN, FNP-C
• Aaliyah Dianne Wallace

• Registered Dietitian in Washington, DC
• Providers in Washington, DC by specialty
• Registered Dietitian in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.