Individual
MR. SHAY F GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-5322
(860) 358-6298
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-5322
(860) 358-6298
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
003655
CT
363LA2100X
Acute Care Nurse Practitioner
Primary
003655
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3V0093
HEALTHNET
CT
01
—
400003655CT
ANTHEM
CT
Enumeration date
10/17/2007
Last updated
03/11/2014
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