MEDICARE: MISS SHONDRA NICOLE SHORTS MA CCC-SLP

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	235Z00000X	Speech-Language Pathologist	05386	MD

General Provider Information

NPI Number	:	1851519938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHONDRA NICOLE SHORTS MA CCC-SLP

Provider Business Mailing Address
First Line	:	9102 THISTLEDOWN RD APT 270
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-8262
Country	:	US
Telephone Number	:	443-660-8102
Fax Number	:	443-660-8102

Provider Business Practice Location Address
First Line	:	1415 MARLTON PIKE E
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-2210
Country	:	US
Telephone Number	:	800-670-3893
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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