MEDICARE: SHANNON THOMAS

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1083028385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON THOMAS

Provider Business Mailing Address
First Line	:	9151 S NORMANDY LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-3627
Country	:	US
Telephone Number	:	937-838-2122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1037 CAMBRIDGE STATION RD APT D
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1910
Country	:	US
Telephone Number	:	347-872-9135
Fax Number	:

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

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	02/02/2026

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Directions to “ SHANNON THOMAS ” Practice Location

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