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NPI Code Detail

MEDICARE: GWENDOLYN A SHORT

MEDICARE: GWENDOLYN A 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
1163W00000XRegistered Nurse355970NY

General Provider Information

NPI Number : 1912850371
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN A SHORT
Provider Business Mailing Address
First Line : 10003 93RD AVE
Second Line :
City : RICHMOND HILL
State : NY
Zip : 11418-2908
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1358 56TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-4616
Country : US
Telephone Number : 718-851-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2026
Last Update Date : 02/17/2026

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Directions to “ GWENDOLYN A SHORT ” Practice Location

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