Provider Demographics
NPI:1851622872
Name:GREEN, SHAWN UREL (BA)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:UREL
Last Name:GREEN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 ZORIA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2634
Mailing Address - Country:US
Mailing Address - Phone:408-348-0338
Mailing Address - Fax:
Practice Address - Street 1:2244 ZORIA CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2634
Practice Address - Country:US
Practice Address - Phone:408-348-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator