Provider Demographics
NPI:1053149161
Name:CHIN-GREEN, SHELEEN A
Entity type:Individual
Prefix:
First Name:SHELEEN
Middle Name:A
Last Name:CHIN-GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELEEN
Other - Middle Name:A
Other - Last Name:CHIN-GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1303
Mailing Address - Country:US
Mailing Address - Phone:914-484-7161
Mailing Address - Fax:
Practice Address - Street 1:47 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1303
Practice Address - Country:US
Practice Address - Phone:914-484-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
IL15175374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula