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General NPI Number Information
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NPI Number | 1003609777
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Entity Type | Individual
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Provider Name | SHERYL LASHELL GREEN LMBT
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Gender | Female
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2403 WOOTEN BLVD SW STE C-D
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City | WILSON
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State | NC
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Zip | 27893-4463
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Country | US
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Telephone | 252-206-3483
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 STARSHIP LN NW
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City | WILSON
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State | NC
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Zip | 27896-9138
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Country | US
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Telephone | 252-640-8224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 22355
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License Number State | NC
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