Healthcare Provider Details

I. General information

NPI: 1871056879
Provider Name (Legal Business Name): SHIKERRIA GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 07/20/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N SUNCOAST BLVD
CRYSTAL RIVER FL
34428-6712
US

IV. Provider business mailing address

PO BOX 140106
GAINESVILLE FL
32614-0106
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-6560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME157860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: