Shanaya E Green

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

71010833A Issued in IN

Practice address

7640 Basswood Dr
Avon, IN 46123-7564

Phone

(803) 915-1774

NPI assigned

Feb 24, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1614124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1669066288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7640 BASSWOOD DR",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461237564",
            "telephone_number": "803-915-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7640 BASSWOOD DR",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461237564",
            "telephone_number": "803-915-1774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "SHANAYA",
        "middle_name": "E",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-24",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71010833A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mersadez Gomez
• Cynecqua Goodridge, MSW
• Darla J Gowan, NP
• Tess Marie Graham, PT, DPT, ATC
• Kimberly Green
• Heather M Greenwell, MSW, LCSW
• Timothy M Greer, D.D.S.
• Amanda Christine Gregory, RN
• Kathy Gretton, FNP
• Melissa Grimes, FNP

• Adult Health Nurse Practitioner in Avon, IN
• Providers in Avon, IN by specialty
• Adult Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; 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.