Provider Demographics
NPI:1760446553
Name:THOMAS, SHEILLA (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHEILLA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 MAIN ST
Mailing Address - Street 2:MICHAEL HALL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-3316
Mailing Address - Fax:716-829-2564
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:MICHAEL HALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-3316
Practice Address - Fax:716-289-2564
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-304127-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02675390Medicaid
NY02675390Medicaid
NYQ46261Medicare UPIN