MEDICARE: DEMETRIA ABDUALYNN THOMAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	106S00000X	Behavior Technician	TX
2	3747P1801X	Personal Care Attendant	TX
3	376J00000X	Homemaker	TX
4	376K00000X	Nurse's Aide	TX
5	3747A0650X	Attendant Care Provider	TX
6	372600000X	Adult Companion	TX
7	374T00000X	Religious Nonmedical Nursing Personnel	TX
8	374U00000X	Home Health Aide	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251E00000X	OTHER	LA	HOME HEALTH

General Provider Information

NPI Number	:	1770180390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIA ABDUALYNN THOMAS

Provider Business Mailing Address
First Line	:	908 AURELIA RD.
Second Line	:	SUITE 200-319
City	:	RICHARDSON
State	:	TX
Zip	:	75081
Country	:	US
Telephone Number	:	214-907-2799
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 AUDELIA RD
Second Line	:	SUITE 200-319
City	:	RICHARDSON
State	:	TX
Zip	:	75081
Country	:	US
Telephone Number	:	214-907-2799
Fax Number	:

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	04/09/2026

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