MEDICARE: SHERRY LEA GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1578075057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY LEA GREEN

Provider Business Mailing Address
First Line	:	239 SUSSEX L
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-6833
Country	:	US
Telephone Number	:	561-401-5764
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 FAIRWAY DRIVE SUITE 101A
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-6407
Country	:	US
Telephone Number	:	954-947-3720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	06/25/2023

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Directions to “ SHERRY LEA GREEN ” Practice Location

Language	Start Address	Practice Location

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