Provider Demographics
NPI:1124599402
Name:HALL-SHORTS, CARMEN MELISSA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MELISSA
Last Name:HALL-SHORTS
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 1:4600 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4371
Mailing Address - Country:US
Mailing Address - Phone:216-431-3434
Mailing Address - Fax:
Practice Address - Street 1:4600 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4371
Practice Address - Country:US
Practice Address - Phone:216-431-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program