Provider Demographics
NPI:1417506759
Name:SHORT, LEANDRA
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
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 1:259 HARRY S TRUMAN DR APT 34
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2052
Mailing Address - Country:US
Mailing Address - Phone:202-227-8676
Mailing Address - Fax:
Practice Address - Street 1:604 MELLON ST SE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2538
Practice Address - Country:US
Practice Address - Phone:240-863-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant