Individual
MS. SHANNON GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD CDE CSR LDN
Contact information
Practice address
1011 INGLESIDE AVE, CATONSVILLE, MD 21228-1318
(410) 877-6077
(410) 877-6087
Mailing address
51 HORSEMAN CT, RANDALLSTOWN, MD 21133-4065
(410) 877-6077
(410) 877-6087
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
D01526
MD
133NN1002X
Nutrition Education Nutritionist
D01526
MD
133V00000X
Registered Dietitian
Primary
D01526
MD
133V00000X
Registered Dietitian
DI100000367
DC
133VN1004X
Pediatric Nutrition Registered Dietitian
D01526
MD
133VN1005X
Renal Nutrition Registered Dietitian
D01526
MD
133VN1006X
Metabolic Nutrition Registered Dietitian
D01526
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122754
UNITEDHEALTHCARE
—
01
—
3072804
AETNA, HMO
MD
05
—
400754900
—
MD
01
—
61553701
CAREFIRST BLUE CROSS BLUE SHIEDL
MD
01
—
7455454
AETNA,NON HMO
MD
01
—
G3980001
GROUP HOSPITALIZATION AND MEDICAL SERVICES, INC
MD
Enumeration date
01/15/2007
Last updated
02/01/2012
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