Provider Demographics
NPI:1174683031
Name:WOODY, SHELLEY DORAE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:DORAE
Last Name:WOODY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:DORAE
Other - Last Name:WOODY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:4412 MITCHELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3112
Practice Address - Country:US
Practice Address - Phone:301-809-0000
Practice Address - Fax:301-809-0000
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist