National Provider Identifier
Shanise Thomas
Shanise Thomas is listed in the NPPES registry with a primary specialty of Physician Assistant in Ithaca, NY and a listed phone number of (607) 272-7000.
Profile Overview
- NPI
- 1023647013
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- April 02, 2020
- Last Updated
- November 11, 2020
Practice Location
- 16 Brentwood Dr Ste A
- Ithaca, NY 14850-1863
Phone: (607) 272-7000
Specialties
- Physician Assistant (363A00000X)
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1023647013
- Entity Type
- Individual
- Last Name
- Thomas
- First Name
- Shanise
- Mailing Street Address
- 16 Brentwood Dr Ste A
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-1863
- Mailing Country
- US
- Practice Street Address
- 16 Brentwood Dr Ste A
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-1863
- Practice Country
- US
- Practice Phone
- (607) 272-7000
- Enumeration Date
- April 02, 2020
- Last Updated
- November 11, 2020
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- November 11, 2020
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X), Physician Assistant (363A00000X)