Provider Demographics
NPI:1891579652
Name:THOMAS, SHANA
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
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 1:301 CLARK PL
Mailing Address - Street 2:
Mailing Address - City:MAYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12543-1007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 CLARK PL
Practice Address - Street 2:
Practice Address - City:MAYBROOK
Practice Address - State:NY
Practice Address - Zip Code:12543-1007
Practice Address - Country:US
Practice Address - Phone:845-270-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672545163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health