Provider Demographics
NPI:1578333647
Name:GREEN, SHAMIRA DEMETRIA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHAMIRA
Middle Name:DEMETRIA
Last Name:GREEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WHISPERING PINES AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4911
Mailing Address - Country:US
Mailing Address - Phone:713-429-5325
Mailing Address - Fax:
Practice Address - Street 1:104 WHISPERING PINES AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4911
Practice Address - Country:US
Practice Address - Phone:713-429-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1131959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty