Provider Demographics
NPI:1386072676
Name:THOMAS, SHASHAI TAMARA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHASHAI
Middle Name:TAMARA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E 137TH ST APT 17D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3912
Mailing Address - Country:US
Mailing Address - Phone:646-841-5103
Mailing Address - Fax:
Practice Address - Street 1:1495 E 28TH ST APT 2D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1872
Practice Address - Country:US
Practice Address - Phone:954-913-5275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310754-1164W00000X
NYF350431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse