Healthcare Provider Details

I. General information

NPI: 1689510604
Provider Name (Legal Business Name): MICHELLE SADIFA THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 WINCHESTER AVE
HILLSIDE NJ
07205-3123
US

IV. Provider business mailing address

856 WINCHESTER AVE
HILLSIDE NJ
07205-3123
US

V. Phone/Fax

Practice location:
  • Phone: 347-419-7391
  • Fax:
Mailing address:
  • Phone: 347-419-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NR24603200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: