Provider Demographics
NPI:1023574951
Name:THOMAS, SHAYNE ANTHONY
Entity Type:Individual
Prefix:
First Name:SHAYNE
Middle Name:ANTHONY
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 MAIN ST # LL20
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6431
Mailing Address - Country:US
Mailing Address - Phone:646-666-3088
Mailing Address - Fax:
Practice Address - Street 1:600 W 138TH ST BSMT
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7822
Practice Address - Country:US
Practice Address - Phone:347-536-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician