Provider Demographics
NPI:1639573215
Name:GREEN, SHECOLBY LEMAY I
Entity Type:Individual
Prefix:MS
First Name:SHECOLBY
Middle Name:LEMAY
Last Name:GREEN
Suffix:I
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 1:5517 JOHN C LODGE FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3346
Mailing Address - Country:US
Mailing Address - Phone:313-492-2781
Mailing Address - Fax:313-895-2867
Practice Address - Street 1:6900 MCGRAW ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-1936
Practice Address - Country:US
Practice Address - Phone:313-895-2860
Practice Address - Fax:313-895-2867
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other