Shannon Green, RD CDE CSR LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D01526 Issued in MD

Practice address

1011 Ingleside Ave
Catonsville, MD 21228-1318

Phone

(410) 877-6077

Fax

(410) 877-6087

NPI assigned

Jan 15, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1164573275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 HORSEMAN CT",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211334065",
            "telephone_number": "410-877-6077",
            "fax_number": "410-877-6087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 INGLESIDE AVE",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212281318",
            "telephone_number": "410-877-6077",
            "fax_number": "410-877-6087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "SHANNON",
        "name_prefix": "Ms.",
        "credential": "RD CDE CSR LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MD",
            "license": "D01526",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "DC",
            "license": "DI100000367",
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "MD",
            "license": "D01526",
            "primary": false
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": "MD",
            "license": "D01526",
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "MD",
            "license": "D01526",
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "MD",
            "license": "D01526",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "MD",
            "license": "D01526",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS BLUE SHIEDL",
            "identifier": "61553701",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HOSPITALIZATION AND MEDICAL SERVICES, INC",
            "identifier": "G3980001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA, HMO",
            "identifier": "3072804",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400754900",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA,NON HMO",
            "identifier": "7455454",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE",
            "identifier": "2122754",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greater Maryland Pain Management, LLC
• John A Greco, PA-C
• Rosalind Green Barnes, LCSWC
• Crystal B Green-Randle
• Sarah Green, LCPC
• Alyssa Gregor, LMSW
• Brandi Grier, LGPC
• Hope U Griffin, MD
• Jennifer J Griffin, DDS
• Jessica Caley Devlin Grisard, LCSW-C

• Registered Dietitian in Catonsville, MD
• Providers in Catonsville, MD by specialty
• Registered Dietitian in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.