Provider Demographics
NPI:1760863146
Name:GREENE, SHAKEIA
Entity Type:Individual
Prefix:
First Name:SHAKEIA
Middle Name:
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 1:1469 EAST AVE
Mailing Address - Street 2:8A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7519
Mailing Address - Country:US
Mailing Address - Phone:347-837-0892
Mailing Address - Fax:
Practice Address - Street 1:861 PARK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-7300
Practice Address - Country:US
Practice Address - Phone:718-828-2666
Practice Address - Fax:718-782-1538
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308215164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse