Provider Demographics
NPI:1699175109
Name:SHUKIS, THOMAS SCOTT
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
Last Name:SHUKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 CATON AVE
Mailing Address - Street 2:APARTMENT 6D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2597
Mailing Address - Country:US
Mailing Address - Phone:518-813-0587
Mailing Address - Fax:
Practice Address - Street 1:50 BROADWAY
Practice Address - Street 2:SUITE 1108
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1607
Practice Address - Country:US
Practice Address - Phone:212-614-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor