Provider Demographics
NPI:1851775886
Name:WOODS, SHAWANDA
Entity Type:Individual
Prefix:
First Name:SHAWANDA
Middle Name:
Last Name:WOODS
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 1:934 N UNIVERSITY DR
Mailing Address - Street 2:# 206
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7029
Mailing Address - Country:US
Mailing Address - Phone:954-210-6070
Mailing Address - Fax:888-900-2325
Practice Address - Street 1:122 HILLSDALE DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6856
Practice Address - Country:US
Practice Address - Phone:954-210-6070
Practice Address - Fax:888-900-2325
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical