Healthcare Provider Details

I. General information

NPI: 1437099488
Provider Name (Legal Business Name): SANDRA ANN SHORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 58TH ST
PULLMAN MI
49450-9761
US

IV. Provider business mailing address

1160 58TH ST
PULLMAN MI
49450-9761
US

V. Phone/Fax

Practice location:
  • Phone: 269-455-0369
  • Fax:
Mailing address:
  • Phone: 269-455-0369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: