MEDICARE: SHAWN WAYNE THOMAS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	OS10348	FL
2	208800000X	Urology Physician	0S013305	PA
3	208800000X	Urology Physician	2603	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043416506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN WAYNE THOMAS D.O.

Provider Business Mailing Address
First Line	:	300 CLYDE MORRIS BLVD STE C
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5909
Country	:	US
Telephone Number	:	386-673-5100
Fax Number	:	386-673-6014

Provider Business Practice Location Address
First Line	:	300 CLYDE MORRIS BLVD STE C
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5909
Country	:	US
Telephone Number	:	386-673-5100
Fax Number	:	386-673-6014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	09/03/2025

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Directions to “ SHAWN WAYNE THOMAS D.O.” Practice Location

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