Provider Demographics
NPI:1497047179
Name:DR. SHELLEY WOODY, LLC
Entity Type:Organization
Organization Name:DR. SHELLEY WOODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:DORAE
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-590-8625
Mailing Address - Street 1:575 E ORDNANCE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6555
Mailing Address - Country:US
Mailing Address - Phone:410-590-8625
Mailing Address - Fax:410-590-8648
Practice Address - Street 1:575 E ORDNANCE RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6555
Practice Address - Country:US
Practice Address - Phone:410-590-8625
Practice Address - Fax:410-590-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty