Healthcare Provider Details

I. General information

NPI: 1144462383
Provider Name (Legal Business Name): SHAYNA MARIE WOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PLZ
MOUNTAIN HOME AR
72653-2918
US

IV. Provider business mailing address

9601 INTERSTATE 630
LITTLE ROCK AR
72205-7202
US

V. Phone/Fax

Practice location:
  • Phone: 870-219-0428
  • Fax: 870-424-3826
Mailing address:
  • Phone: 501-225-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-6687
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberE-6687
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: