MEDICARE: ASHLEY GREEN PA-C

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	363A00000X	Physician Assistant	017061	NY

General Provider Information

NPI Number	:	1760810147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GREEN PA-C

Provider Business Mailing Address
First Line	:	410 EVERNIA ST APT 219
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5433
Country	:	US
Telephone Number	:	301-905-8777
Fax Number	:	561-468-4480

Provider Business Practice Location Address
First Line	:	50 COCOANUT ROW STE 100
Second Line	:
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4027
Country	:	US
Telephone Number	:	561-200-7000
Fax Number	:	561-468-4480

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

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	05/29/2024

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Directions to “ ASHLEY GREEN PA-C” Practice Location

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