Provider Demographics
NPI:1962873356
Name:GREENE, KELLY (NBC-HIS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 PGA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3987
Mailing Address - Country:US
Mailing Address - Phone:561-630-9350
Mailing Address - Fax:
Practice Address - Street 1:5540 PGA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3987
Practice Address - Country:US
Practice Address - Phone:561-630-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2697237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist