Provider Demographics
NPI:1538931373
Name:SHORT, TARA L
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:SHORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 606265
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-0265
Mailing Address - Country:US
Mailing Address - Phone:216-200-9133
Mailing Address - Fax:
Practice Address - Street 1:23951 LAKE SHORE BLVD APT B613
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1210
Practice Address - Country:US
Practice Address - Phone:216-200-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide