Provider Demographics
NPI:1518472307
Name:SHORT, AMANDA CAROLINE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAROLINE
Last Name:SHORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CAROLINE
Other - Last Name:ALBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20528 BLUEBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4424
Mailing Address - Country:US
Mailing Address - Phone:240-357-3050
Mailing Address - Fax:
Practice Address - Street 1:120 BELLVIEW AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3142
Practice Address - Country:US
Practice Address - Phone:540-542-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-03
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst