Provider Demographics
NPI:1003609777
Name:GREEN, SHERYL LASHELL (LMBT)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:LASHELL
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 STARSHIP LN NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-9138
Mailing Address - Country:US
Mailing Address - Phone:252-640-8224
Mailing Address - Fax:
Practice Address - Street 1:2403 WOOTEN BLVD SW STE C-D
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4463
Practice Address - Country:US
Practice Address - Phone:252-206-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist