Provider Demographics
NPI:1235636606
Name:WOODY, EMILY C (MPH, RDN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:C
Last Name:WOODY
Suffix:
Gender:F
Credentials:MPH, RDN, IBCLC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:C
Other - Last Name:CLEAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RDN, IBCLC
Mailing Address - Street 1:500 25TH PL NE APT 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5086
Mailing Address - Country:US
Mailing Address - Phone:908-917-9386
Mailing Address - Fax:
Practice Address - Street 1:4927 AUBURN AVE STE 100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2641
Practice Address - Country:US
Practice Address - Phone:301-943-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1029527133V00000X
DCL-102668174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered