Provider Demographics
NPI:1114940319
Name:SHORT, DANIEL NEWTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NEWTON
Last Name:SHORT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9855 E LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5145
Mailing Address - Country:US
Mailing Address - Phone:480-392-5359
Mailing Address - Fax:602-718-5110
Practice Address - Street 1:9855 E LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5145
Practice Address - Country:US
Practice Address - Phone:480-329-5359
Practice Address - Fax:602-718-5110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3499103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75552Medicare ID - Type UnspecifiedPSYCHOLOGIST