Provider Demographics
NPI:1619516598
Name:GREENE, ELSIE SHEA (MED, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:SHEA
Last Name:GREENE
Suffix:
Gender:F
Credentials:MED, CF-SLP
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:SHEA
Other - Last Name:MCCULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2006 FARRAND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-3406
Mailing Address - Country:US
Mailing Address - Phone:757-604-9465
Mailing Address - Fax:
Practice Address - Street 1:3600 SAUNDERS AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4328
Practice Address - Country:US
Practice Address - Phone:804-358-1874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist