Individual
SHAVONNA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2889 ROSEDALE DR, ORANGEBURG, SC 29115-8428
(804) 570-6736
Mailing address
2889 ROSEDALE DR, ORANGEBURG, SC 29115-8428
(804) 570-6736
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
11/18/2019
Last updated
11/18/2019
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