MEDICARE: CALLIE 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	101200000X	Drama Therapist	003044	NY

General Provider Information

NPI Number	:	1982554481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLIE SHORT

Provider Business Mailing Address
First Line	:	2819 23RD AVE APT 2
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-2719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 23RD AVE APT 2
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-2719
Country	:	US
Telephone Number	:	718-296-2654
Fax Number	:

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

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

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Directions to “ CALLIE SHORT ” Practice Location

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