Provider Demographics
NPI:1841886363
Name:SHORTY, RONALDA
Entity type:Individual
Prefix:MRS
First Name:RONALDA
Middle Name:
Last Name:SHORTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:308 ARNO ST NE APT A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3509
Mailing Address - Country:US
Mailing Address - Phone:505-302-5383
Mailing Address - Fax:505-295-4189
Practice Address - Street 1:308 ARNO ST NE APT A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3509
Practice Address - Country:US
Practice Address - Phone:505-302-5383
Practice Address - Fax:505-295-4189
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician