Individual
DR. SYDNEY GLEN SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
568 RUIN CREEK RD STE 128, HENDERSON, NC 27536-5921
(252) 436-1085
Mailing address
1030 SIENA DRIVE, WAKE FOREST, NC 27587
(910) 734-4391
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
28344
ND
207RC0000X
Cardiovascular Disease Physician
Primary
28344
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053411165
—
NC
Enumeration date
09/25/2006
Last updated
07/01/2024
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