MEDICARE: SKYLAR SHORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		MD

General Provider Information

NPI Number	:	1821920901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR SHORT

Provider Business Mailing Address
First Line	:	59 MAIDEN LN
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4502
Country	:	US
Telephone Number	:
Fax Number	:	877-669-9140

Provider Business Practice Location Address
First Line	:	59 MAIDEN LN
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4502
Country	:	US
Telephone Number	:	877-669-9140
Fax Number	:	877-669-9140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/16/2026

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Directions to “ SKYLAR SHORT ” Practice Location

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