Provider Demographics
NPI:1982831350
Name:SHORTLAND, BILLY DAVID (CHAP)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:DAVID
Last Name:SHORTLAND
Suffix:
Gender:M
Credentials:CHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 DING HOW LANE
Mailing Address - Street 2:BOX 51
Mailing Address - City:OLD HARBOR
Mailing Address - State:AK
Mailing Address - Zip Code:99643
Mailing Address - Country:US
Mailing Address - Phone:907-286-2232
Mailing Address - Fax:
Practice Address - Street 1:214 DING HOW LANE
Practice Address - Street 2:BOX 51
Practice Address - City:OLD HARBOR
Practice Address - State:AK
Practice Address - Zip Code:99643
Practice Address - Country:US
Practice Address - Phone:907-286-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker