Healthcare Provider Details

I. General information

NPI: 1376786269
Provider Name (Legal Business Name): STEPHANIE SEREDA SHORT R.D.H
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18217 HALE AVE
MORGAN HILL CA
95037-3550
US

IV. Provider business mailing address

18225 HALE AVE
MORGAN HILL CA
95037-3547
US

V. Phone/Fax

Practice location:
  • Phone: 408-465-8280
  • Fax: 408-465-8281
Mailing address:
  • Phone: 408-465-8280
  • Fax: 408-465-8281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13059
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: