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Contact Information

SHANNON GREEN, RD CDE CSR LDN
1011 INGLESIDE AVE
CATONSVILLE, MD21228-1318
 Phone: 410-877-6077
 Fax: 410-877-6087
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

Nutrition, Education

133NN1002X
 

Nutrition, Metabolic

133VN1006X 71 Registered Dietitian or Nutrition Professional
 

Nutrition, Pediatric

133VN1004X 71 Registered Dietitian or Nutrition Professional
 

Nutrition, Renal

133VN1005X 71 Registered Dietitian or Nutrition Professional
 

Nutritionist

133N00000X
Indicates primary specialty

NPI Profile & details for SHANNON GREEN · (Female)

NPI # 1164573275
Status Active
Credentials RD CDE CSR LDN
Entity Individual
Enumeration date 01/15/2007
Last updated 02/01/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • DC License # DI100000367
  • MD License # D01526
  • MD Medicaid 400754900
  • Other 2122754 UNITEDHEALTHCARE
  • MD Other 3072804 AETNA, HMO
  • MD Other 7455454 AETNA,NON HMO
  • MD Other 61553701 CAREFIRST BLUE CROSS BLUE SHIEDL
  • MD Other G3980001 GROUP HOSPITALIZATION AND MEDICAL SERVICES, INC
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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