Healthcare Provider Details

I. General information

NPI: 1992669832
Provider Name (Legal Business Name): SHEA GREEN EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 STYSLY LN
SPRING VALLEY NY
10977-2509
US

IV. Provider business mailing address

6 STYSLY LN
SPRING VALLEY NY
10977-2509
US

V. Phone/Fax

Practice location:
  • Phone: 845-263-6999
  • Fax:
Mailing address:
  • Phone: 845-263-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number462782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: