Provider Demographics
NPI:1104021070
Name:THOMAS, TANYA SANITA (MD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SANITA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-6021
Mailing Address - Country:US
Mailing Address - Phone:401-440-1012
Mailing Address - Fax:
Practice Address - Street 1:450 BROOK ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2231
Practice Address - Country:US
Practice Address - Phone:401-863-3476
Practice Address - Fax:401-863-3607
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD133582084P0800X
RILP012462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry