Healthcare Provider Details

I. General information

NPI: 1457237299
Provider Name (Legal Business Name): CATRINA SHADIYYAH GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 CHAPMAN RD # 223
NEWARK DE
19702-5413
US

IV. Provider business mailing address

7000 INNOVATION DRIVE 7107
ELKTON MD
21921
US

V. Phone/Fax

Practice location:
  • Phone: 302-374-2017
  • Fax:
Mailing address:
  • Phone: 215-272-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: