Provider Demographics
NPI:1548026370
Name:SHORT, MEGHAN (PRSS)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 W STREETSBORO ST APT C
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2068
Mailing Address - Country:US
Mailing Address - Phone:661-703-7232
Mailing Address - Fax:
Practice Address - Street 1:223 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2741
Practice Address - Country:US
Practice Address - Phone:330-577-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004689175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist