Provider Demographics
NPI:1356654479
Name:SHORT, JUSTINE YUMIE (MAC, LAC)
Entity type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:YUMIE
Last Name:SHORT
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4915
Mailing Address - Country:US
Mailing Address - Phone:301-906-5713
Mailing Address - Fax:
Practice Address - Street 1:8555 16TH ST STE 402
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2802
Practice Address - Country:US
Practice Address - Phone:301-906-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01831171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist