MEDICARE: IEISHA RENE WOODY

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	305R00000X	Preferred Provider Organization		OH

General Provider Information

NPI Number	:	1558025882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IEISHA RENE WOODY

Provider Business Mailing Address
First Line	:	840 E 154TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-3006
Country	:	US
Telephone Number	:	216-925-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 E 154TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-3006
Country	:	US
Telephone Number	:	216-925-7171
Fax Number	:

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

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	10/22/2021

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Directions to “ IEISHA RENE WOODY ” Practice Location

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