Provider Demographics
NPI:1902358229
Name:THOMAS, NISHI
Entity Type:Individual
Prefix:
First Name:NISHI
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 1:1820 SOUTHWEST EXPY
Mailing Address - Street 2:APT 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4437
Mailing Address - Country:US
Mailing Address - Phone:408-722-1942
Mailing Address - Fax:
Practice Address - Street 1:826 N WINCHESTER BLVD
Practice Address - Street 2:SUITE 2G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1313
Practice Address - Country:US
Practice Address - Phone:408-337-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP16662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist