Healthcare Provider Details

I. General information

NPI: 1558287375
Provider Name (Legal Business Name): THOMAS SHEA PICKELS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19203 COMPASS ROSE CT
CORNELIUS NC
28031-7588
US

IV. Provider business mailing address

19203 COMPASS ROSE CT
CORNELIUS NC
28031-7588
US

V. Phone/Fax

Practice location:
  • Phone: 703-678-5071
  • Fax:
Mailing address:
  • Phone: 703-678-5071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: