Provider Demographics
NPI:1003459512
Name:GREEN, SHAH-MONEKE ANJONETTE
Entity Type:Individual
Prefix:MS
First Name:SHAH-MONEKE
Middle Name:ANJONETTE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SE 48TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2265
Mailing Address - Country:US
Mailing Address - Phone:470-808-9070
Mailing Address - Fax:
Practice Address - Street 1:3800 SE 48TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-2265
Practice Address - Country:US
Practice Address - Phone:470-808-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator