Healthcare Provider Details

I. General information

NPI: 1619376373
Provider Name (Legal Business Name): SHANNA WOODWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 E SCOTTLAND RD
COVINGTON VA
24426-2320
US

IV. Provider business mailing address

523 E SCOTTLAND RD
COVINGTON VA
24426-2320
US

V. Phone/Fax

Practice location:
  • Phone: 540-968-0863
  • Fax:
Mailing address:
  • Phone: 540-968-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: