Provider Demographics
NPI:1689434201
Name:SLOOP, THAIS CARVALHO (DO)
Entity Type:Individual
Prefix:
First Name:THAIS
Middle Name:CARVALHO
Last Name:SLOOP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:THAIS
Other - Middle Name:
Other - Last Name:FREGONESI DE CARVALHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 PROVIDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-7666
Mailing Address - Country:US
Mailing Address - Phone:479-502-6011
Mailing Address - Fax:
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-446-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program