Provider Demographics
NPI:1639407281
Name:GREENE, SHARON (SLP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10007 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1148
Mailing Address - Country:US
Mailing Address - Phone:443-878-3475
Mailing Address - Fax:
Practice Address - Street 1:10007 VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1148
Practice Address - Country:US
Practice Address - Phone:443-878-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist