Provider Demographics
NPI:1881270833
Name:WOODS, SHANEKA (CPT)
Entity type:Individual
Prefix:
First Name:SHANEKA
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 CARPENTIER ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4422
Mailing Address - Country:US
Mailing Address - Phone:510-827-9131
Mailing Address - Fax:
Practice Address - Street 1:1795 CARPENTIER ST APT A
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4422
Practice Address - Country:US
Practice Address - Phone:510-827-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-02160924246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty