Provider Demographics
NPI:1356083356
Name:THAMBI, SHEEBAMOL (NP)
Entity Type:Individual
Prefix:
First Name:SHEEBAMOL
Middle Name:
Last Name:THAMBI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25222 BOULDER BEND LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6456
Mailing Address - Country:US
Mailing Address - Phone:845-270-5524
Mailing Address - Fax:
Practice Address - Street 1:25222 BOULDER BEND LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6456
Practice Address - Country:US
Practice Address - Phone:845-270-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty