Green, Shannon

Green, Shannon is an individual health care provider with primary practice located at 1011 Ingleside Ave , Catonsville MD 21228-1318. She recently has 6 registered licenses in different health care specialties including Dietary & Nutritional Service Providers / Dietitian, Registered, Dietary & Nutritional Service Providers / Nutrition, Metabolic, Dietary & Nutritional Service Providers / Nutrition, Renal, Dietary & Nutritional Service Providers / Nutritionist, Dietary & Nutritional Service Providers / Nutrition, Education, Dietary & Nutritional Service Providers / Nutrition, Pediatric. Dietary & Nutritional Service Providers / Dietitian, Registered is her primary health care specialty. Green, Shannon can be contacted via phone (410) 877-6077.

Contact Information

Primary practice address
1011 Ingleside Ave Catonsville MD 21228-1318
Phone: (410) 877-6077
Fax: (410) 877-6087
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X D01526 Maryland
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X DI100000367 District of Columbia
Dietary & Nutritional Service Providers / Nutrition, Metabolic 133VN1006X D01526 Maryland
Dietary & Nutritional Service Providers / Nutrition, Renal 133VN1005X D01526 Maryland
Dietary & Nutritional Service Providers / Nutritionist 133N00000X D01526 Maryland
Dietary & Nutritional Service Providers / Nutrition, Education 133NN1002X D01526 Maryland
Dietary & Nutritional Service Providers / Nutrition, Pediatric 133VN1004X D01526 Maryland

Profile Details

NPI number 1164573275
LBN Legal business name Green, Shannon
Credentials RD CDE CSR LDN
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 15th, 2007
Last updated Feb 1st, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164573275 NPPES
Maryland Other 61553701 CAREFIRST BLUE CROSS BLUE SHIEDL
Maryland Other G3980001 CAREFIRST BLUE CROSS BLUE SHIEDL
Maryland Other 3072804 CAREFIRST BLUE CROSS BLUE SHIEDL
Maryland MEDICAID 400754900 CAREFIRST BLUE CROSS BLUE SHIEDL
Maryland Other 7455454 CAREFIRST BLUE CROSS BLUE SHIEDL
Maryland Other 2122754 CAREFIRST BLUE CROSS BLUE SHIEDL

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