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General NPI Number Information
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NPI Number | 1295438729
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Entity Type | Individual
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Provider Name | SHAMORRA J THOMAS
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Gender | Female
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 220 PARK MANOR DR APT 2A
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City | DAYTON
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State | OH
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Zip | 45410-1152
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Country | US
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Telephone | 937-278-6092
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Fax |
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Provider Business Mailing Address
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Address Line | 5019 NORTHCREST DR APT C
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City | DAYTON
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State | OH
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Zip | 45414-3773
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Country | US
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Telephone | 937-939-9198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 401635420414
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License Number State | OH
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