Healthcare Provider Details

I. General information

NPI: 1164802153
Provider Name (Legal Business Name): SALLY WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-7355
  • Fax:
Mailing address:
  • Phone: 513-585-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35132060
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: