Provider Demographics
NPI:1063686384
Name:LEWIS, SHANTELL DENISE (MS CCCA FAAA)
Entity Type:Individual
Prefix:MS
First Name:SHANTELL
Middle Name:DENISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS CCCA FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MOOREFIELD PARK DR STE 100
Mailing Address - Street 2:VIRGINIA PROFESSIONAL HEARING HEALTH CENTER
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3692
Mailing Address - Country:US
Mailing Address - Phone:804-330-1350
Mailing Address - Fax:
Practice Address - Street 1:620 MOOREFIELD PARK DRIVE SUITE 100
Practice Address - Street 2:VIRGINIA PROFESSIONAL HEARING HEALTHCARE CENTER
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236
Practice Address - Country:US
Practice Address - Phone:804-330-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001199231H00000X
VA237600000X
VA2101001651237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist