Provider Demographics
NPI:1205229465
Name:GRECO, SHEENA (NP)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:GRECO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:
Other - Last Name:SERVANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9401 GOTHIC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2812
Mailing Address - Country:US
Mailing Address - Phone:818-621-1338
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:SUITE 505C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43430892363LA2100X
CA95000701363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care