Provider Demographics
NPI:1861927774
Name:THOMAS, SHIRIN FARAH (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:FARAH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:SHIRIN
Other - Middle Name:FARAH
Other - Last Name:BIBAYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, PMHNP
Mailing Address - Street 1:5701 DELMAR BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2617
Mailing Address - Country:US
Mailing Address - Phone:314-367-7848
Mailing Address - Fax:314-367-2985
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8444
Practice Address - Country:US
Practice Address - Phone:678-209-2394
Practice Address - Fax:678-212-6343
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213616363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health