MEDICARE: SHAILENDRA NELLE THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	36815	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619222858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAILENDRA NELLE THOMAS

Provider Business Mailing Address
First Line	:	5316 TRAIL LAKE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1931
Country	:	US
Telephone Number	:	817-292-8787
Fax Number	:	817-789-6849

Provider Business Practice Location Address
First Line	:	1126 W PIONEER PKWY
Second Line	:	# 1126
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6367
Country	:	US
Telephone Number	:	817-795-1291
Fax Number	:	817-789-6849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/13/2012

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Directions to “ SHAILENDRA NELLE THOMAS ” Practice Location

Language	Start Address	Practice Location

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