Provider Demographics
NPI:1225380348
Name:WOODS, SHELITA Y
Entity Type:Individual
Prefix:
First Name:SHELITA
Middle Name:Y
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 ANCHOR WAY
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-6402
Mailing Address - Country:US
Mailing Address - Phone:817-297-3426
Mailing Address - Fax:817-297-3518
Practice Address - Street 1:548 ANCHOR WAY
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-6402
Practice Address - Country:US
Practice Address - Phone:817-297-3426
Practice Address - Fax:817-297-3518
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker