Provider Demographics
NPI:1265112791
Name:THOMAS, SHAUNICE (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:SHAUNICE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SAN SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3286
Mailing Address - Country:US
Mailing Address - Phone:832-673-9074
Mailing Address - Fax:
Practice Address - Street 1:85 SAN SIMEON DR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3286
Practice Address - Country:US
Practice Address - Phone:832-673-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX691019200027246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy