Healthcare Provider Details

I. General information

NPI: 1093471773
Provider Name (Legal Business Name): SHELMY THACHET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W 9TH ST
BROOKLYN NY
11231-2501
US

IV. Provider business mailing address

90 COLGATE AVE
PARAMUS NJ
07652-4332
US

V. Phone/Fax

Practice location:
  • Phone: 718-599-9090
  • Fax: 718-907-1348
Mailing address:
  • Phone: 214-450-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027672
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: