Individual
ALYCIA SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3 LYON PL, OGDENSBURG, NY 13669-2590
(315) 713-6643
Mailing address
3 LYON PL, OGDENSBURG, NY 13669-2590
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
022701
NY
363AM0700X
Medical Physician Assistant
Primary
022701
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05448137
—
NY
Enumeration date
10/02/2018
Last updated
12/29/2021
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