Provider Demographics
NPI:1497631089
Name:THOMAS, SHANTEL L
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:L
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 1:1 S COLLEGE ST UNIT 2271
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4856
Mailing Address - Country:US
Mailing Address - Phone:281-748-7235
Mailing Address - Fax:
Practice Address - Street 1:12 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-2066
Practice Address - Country:US
Practice Address - Phone:888-609-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant