| NPI | 1154393940 |
|---|---|
| Former Name | SHANNON ELIZABETH SHORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101016653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 260251) |
| 207Q00000X Family Medicine (Licence: CT 52347) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2025-06-25 |