Provider Information for 1073199048
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Mr. KYLE SHORT
Sex: Male
NPI: 1073199048
Last Updated: 2021-03-22
Certification Date: 2021-03-22
Certification Date: 2021-03-22
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1073199048 | ||||||||
| Enumeration Date | 2021-03-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2500 QUANTUM LAKES DR STE 105 BOYNTON BEACH, FL 33426-8308 United States Phone: 561-770-1780 | Fax:833-562-8893 | ||||||||
| Primary Practice Address | 2500 QUANTUM LAKES DR STE 105 BOYNTON BEACH, FL 33426-8308 United States Phone: 561-770-1780 | Fax:833-562-8893 | ||||||||
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