Healthcare Provider Details

I. General information

NPI: 1235488149
Provider Name (Legal Business Name): NIESHA WOOD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 FORUM PL STE 7
WEST PALM BEACH FL
33401-2330
US

IV. Provider business mailing address

4042 LAKE TAHOE CIR
WEST PALM BEACH FL
33409-7879
US

V. Phone/Fax

Practice location:
  • Phone: 561-712-8821
  • Fax:
Mailing address:
  • Phone: 561-352-3431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: