Basic Information
| Provider Information | |||||||||
| NPI: | 1790331452 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | SHIBY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 REDWOOD LN | ||||||||
| Address2: | |||||||||
| City: | MILLER PLACE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117643030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315615176 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 NICOLLS RD | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117941252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314441066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2019 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F309366-01 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.