Provider Demographics
NPI:1629776851
Name:GREENE, VELVETTEA TOYA
Entity Type:Individual
Prefix:
First Name:VELVETTEA
Middle Name:TOYA
Last Name:GREENE
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 1:50 S PICKETT ST STE 31
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7203
Mailing Address - Country:US
Mailing Address - Phone:703-664-0648
Mailing Address - Fax:
Practice Address - Street 1:50 S PICKETT ST STE 31
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7203
Practice Address - Country:US
Practice Address - Phone:703-664-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier