Healthcare Provider Details

I. General information

NPI: 1881309623
Provider Name (Legal Business Name): SHYLA WOODYARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVENUE SEIDMAN CANCER CENTER 5TH FLOOR
CLEVELAND OH
44106
US

IV. Provider business mailing address

34155 PETTIBONE RD
SOLON OH
44139-5013
US

V. Phone/Fax

Practice location:
  • Phone: 216-286-3555
  • Fax:
Mailing address:
  • Phone: 419-957-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.0033022
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.439927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: