Healthcare Provider Details

I. General information

NPI: 1437788734
Provider Name (Legal Business Name): ALYSSA MARIE SHORT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 09/18/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27020 NORTHWEST FREEWAY
CYPRESS TX
77433
US

IV. Provider business mailing address

27020 NORTHWEST FREEWAY
CYPRESS TX
77433
US

V. Phone/Fax

Practice location:
  • Phone: 713-442-8400
  • Fax:
Mailing address:
  • Phone: 713-442-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU0657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: