Provider Demographics
NPI:1518563626
Name:THOMAS, SELIKA SHANTAYL
Entity Type:Individual
Prefix:
First Name:SELIKA
Middle Name:SHANTAYL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3802
Mailing Address - Country:US
Mailing Address - Phone:510-812-3112
Mailing Address - Fax:
Practice Address - Street 1:2120 64TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-3802
Practice Address - Country:US
Practice Address - Phone:510-812-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies