Provider Demographics
NPI:1164761227
Name:SHORTER, JADE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:MICHELLE
Last Name:SHORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD463653207V00000X
MA260020207V00000X
CAA168919207V00000X, 207VC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology