Provider Demographics
NPI:1467936682
Name:WOODS, SHONTA J (HOME HEALTH PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:SHONTA
Middle Name:J
Last Name:WOODS
Suffix:
Gender:F
Credentials:HOME HEALTH PROVIDER
Other - Prefix:MS
Other - First Name:SHONTA
Other - Middle Name:J
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OWNER
Mailing Address - Street 1:7076 JULIAN AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1938
Mailing Address - Country:US
Mailing Address - Phone:314-688-2453
Mailing Address - Fax:314-688-2453
Practice Address - Street 1:7076 JULIAN AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-1938
Practice Address - Country:US
Practice Address - Phone:314-688-2453
Practice Address - Fax:314-688-2453
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty