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General NPI Number Information
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NPI Number | 1841069689
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Entity Type | Individual
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Provider Name | SHINU M THOMAS
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Gender | Female
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 2 1ST AVE
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City | ORANGEBURG
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State | NY
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Zip | 10962-1106
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Country | US
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Telephone | 845-680-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 29 DORCHESTER DR
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City | AIRMONT
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State | NY
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Zip | 10952-4211
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Country | US
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Telephone | 184-553-6244
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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 | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 595323
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License Number State | NY
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