Provider Demographics
NPI:1811742166
Name:SHUTSKY, THOMAS JOHN
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOHN
Last Name:SHUTSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 SURRY LINE RD
Mailing Address - Street 2:
Mailing Address - City:PINNACLE
Mailing Address - State:NC
Mailing Address - Zip Code:27043-9330
Mailing Address - Country:US
Mailing Address - Phone:860-710-5720
Mailing Address - Fax:
Practice Address - Street 1:1420 SURRY LINE RD
Practice Address - Street 2:
Practice Address - City:PINNACLE
Practice Address - State:NC
Practice Address - Zip Code:27043-9330
Practice Address - Country:US
Practice Address - Phone:860-710-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RH0600XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyHistology