Provider Demographics
NPI:1598337941
Name:SHORTER, KAYDEAN S (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KAYDEAN
Middle Name:S
Last Name:SHORTER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MCEACHRON DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3586
Mailing Address - Country:US
Mailing Address - Phone:508-801-2637
Mailing Address - Fax:
Practice Address - Street 1:460 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8130
Practice Address - Country:US
Practice Address - Phone:617-774-6090
Practice Address - Fax:617-770-3749
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMS7633832364SP0812X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, CommunityGroup - Single Specialty