Healthcare Provider Details

I. General information

NPI: 1386331940
Provider Name (Legal Business Name): SHAMEIKA M THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 E CARTER AVE APT L08
SAINT LOUIS MO
63115-3035
US

IV. Provider business mailing address

4139 E CARTER AVE
SAINT LOUIS MO
63115-3035
US

V. Phone/Fax

Practice location:
  • Phone: 314-314-8659
  • Fax:
Mailing address:
  • Phone: 314-865-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: