MEDICARE: SHAQWANA WOODARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	372600000X	Adult Companion
3	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1114408655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAQWANA WOODARD

Provider Business Mailing Address
First Line	:	41521 W 11 MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48375-1803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6328 SKIPPER LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-2048
Country	:	US
Telephone Number	:	214-414-2008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	01/31/2023

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Directions to “ SHAQWANA WOODARD ” Practice Location

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