Individual
SHANNON GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HHA
Contact information
Practice address
1216 GRAY AVE, UTICA, NY 13502-3959
(315) 864-0416
Mailing address
1216 GRAY AVE, UTICA, NY 13502-3959
(315) 864-0416
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073256616
—
NY
05
—
13502
—
NY
Enumeration date
04/20/2022
Last updated
12/24/2024
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