Provider Demographics
NPI:1255174462
Name:SHORT, DARYN JEANNE
Entity type:Individual
Prefix:
First Name:DARYN
Middle Name:JEANNE
Last Name:SHORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1015
Mailing Address - Country:US
Mailing Address - Phone:484-526-8875
Mailing Address - Fax:
Practice Address - Street 1:800 OSTRUM ST STE 300
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1010
Practice Address - Country:US
Practice Address - Phone:484-526-8875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program