Provider Demographics
NPI:1356808489
Name:SHORT, SHANE MICHAEL (BC-HIS)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:MICHAEL
Last Name:SHORT
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7467
Mailing Address - Country:US
Mailing Address - Phone:501-781-2002
Mailing Address - Fax:
Practice Address - Street 1:4405 CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7467
Practice Address - Country:US
Practice Address - Phone:501-781-2003
Practice Address - Fax:501-781-2003
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR630237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR-630OtherAUDIOMETRIC EVALUATIONS, ADJUSTMENTS, HEARING AID REPAIRS