Provider Demographics
NPI:1407686553
Name:GREENE, SHANNON GENEVIEVE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:GENEVIEVE
Last Name:GREENE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1329 JEFFERSON ST APT 401
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-1856
Mailing Address - Country:US
Mailing Address - Phone:240-435-0260
Mailing Address - Fax:
Practice Address - Street 1:2818 LINKHORNE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-3322
Practice Address - Country:US
Practice Address - Phone:240-435-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110010405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant