Provider Demographics
NPI:1750770699
Name:THOMAS, SHAUNTE (WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:SHAUNTE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14961 W BELL RD
Mailing Address - Street 2:STE 175
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3220
Mailing Address - Country:US
Mailing Address - Phone:623-547-7205
Mailing Address - Fax:623-249-5181
Practice Address - Street 1:14961 W BELL RD
Practice Address - Street 2:STE 175
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3220
Practice Address - Country:US
Practice Address - Phone:623-547-7205
Practice Address - Fax:623-249-5181
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19054363LW0102X
AZRN189894363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health