Provider Demographics
NPI:1093965022
Name:WOODWARD, SHELLY WONG (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:WONG
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-3028
Mailing Address - Country:US
Mailing Address - Phone:908-459-4509
Mailing Address - Fax:908-459-4509
Practice Address - Street 1:111 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07825-3028
Practice Address - Country:US
Practice Address - Phone:908-459-4509
Practice Address - Fax:908-459-4509
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05668700208100000X
MDD37215208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation