Provider Demographics
NPI:1679978886
Name:THOMAS, SIMONE SANORA
Entity type:Individual
Prefix:MISS
First Name:SIMONE
Middle Name:SANORA
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 1:574 SAINT NICHOLAS AVE APT 43
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2024
Mailing Address - Country:US
Mailing Address - Phone:917-536-6412
Mailing Address - Fax:
Practice Address - Street 1:574 SAINT NICHOLAS AVE APT 43
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2024
Practice Address - Country:US
Practice Address - Phone:917-536-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314999164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse