Provider Demographics
NPI:1578840427
Name:THOMAS, SIJI SAJU (APN/MD)
Entity Type:Individual
Prefix:
First Name:SIJI
Middle Name:SAJU
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APN/MD
Other - Prefix:
Other - First Name:SIJI
Other - Middle Name:P
Other - Last Name:ANTONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN/MD
Mailing Address - Street 1:5330 HEATH RIVER LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3382
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX759958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286682401Medicaid
TX861N03OtherBCBS
TXTXB142273Medicare PIN