MEDICARE: AUDREY WOOD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1225920887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY WOOD

Provider Business Mailing Address
First Line	:	1681 SW SOUTHWORTH TER
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-1012
Country	:	US
Telephone Number	:	772-828-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1681 SW SOUTHWORTH TER
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-1012
Country	:	US
Telephone Number	:	772-828-5636
Fax Number	:

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

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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Directions to “ AUDREY WOOD ” Practice Location

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