Provider Demographics
NPI:1982351698
Name:THOMAS, SHAQUALA TYSHAWN
Entity type:Individual
Prefix:MS
First Name:SHAQUALA
Middle Name:TYSHAWN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:OH
Mailing Address - Zip Code:44437-1913
Mailing Address - Country:US
Mailing Address - Phone:614-373-5700
Mailing Address - Fax:
Practice Address - Street 1:325 HAYES AVE
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:OH
Practice Address - Zip Code:44437-1913
Practice Address - Country:US
Practice Address - Phone:614-373-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health