Provider Demographics
NPI:1518482108
Name:WOODALL, SHANDRIA RENEE (MA, RMHCI)
Entity Type:Individual
Prefix:MS
First Name:SHANDRIA
Middle Name:RENEE
Last Name:WOODALL
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9432
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-9432
Mailing Address - Country:US
Mailing Address - Phone:941-524-7654
Mailing Address - Fax:
Practice Address - Street 1:1152 LONGFELLOW RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-1215
Practice Address - Country:US
Practice Address - Phone:941-524-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health