Provider Demographics
NPI:1841431236
Name:SWISSHELM, THOMAS (MED, EDS, BCN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SWISSHELM
Suffix:
Gender:M
Credentials:MED, EDS, BCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 A1A S STE 100
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6523
Mailing Address - Country:US
Mailing Address - Phone:352-514-7143
Mailing Address - Fax:904-758-5401
Practice Address - Street 1:2180 A1A S STE 100
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6523
Practice Address - Country:US
Practice Address - Phone:352-514-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG