Provider Demographics
NPI:1972363216
Name:THOMAS, SHEA ELIZABETH (INTERN)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:ELIZABETH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23804 S 231ST WAY
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1548
Mailing Address - Country:US
Mailing Address - Phone:480-239-0567
Mailing Address - Fax:
Practice Address - Street 1:23804 S 231ST WAY
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-1548
Practice Address - Country:US
Practice Address - Phone:480-239-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program