Healthcare Provider Details

I. General information

NPI: 1841069689
Provider Name (Legal Business Name): SHINU M THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 1ST AVE
ORANGEBURG NY
10962-1106
US

IV. Provider business mailing address

29 DORCHESTER DR
AIRMONT NY
10952-4211
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-4050
  • Fax:
Mailing address:
  • Phone: 184-553-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number595323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: