Healthcare Provider Details

I. General information

NPI: 1801720776
Provider Name (Legal Business Name): WOOD SCOTTIE JEAN LOUIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 REILLY ST
BAY SHORE NY
11706-2612
US

IV. Provider business mailing address

1076 REILLY ST
BAY SHORE NY
11706-2612
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-5009
  • Fax:
Mailing address:
  • Phone: 516-395-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number356250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: