Provider Demographics
NPI:1760965263
Name:WOOD, SHANIAH TAMMICHELLE
Entity Type:Individual
Prefix:
First Name:SHANIAH
Middle Name:TAMMICHELLE
Last Name:WOOD
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 1:1130 AVENUE OF THE OAKS UNIT 509
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4880
Mailing Address - Country:US
Mailing Address - Phone:805-748-8319
Mailing Address - Fax:
Practice Address - Street 1:1130 AVENUE OF THE OAKS UNIT 509
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4880
Practice Address - Country:US
Practice Address - Phone:805-748-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician