Provider Demographics
NPI:1093944498
Name:LEWIS, SHERRIA M (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERRIA
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3523
Mailing Address - Country:US
Mailing Address - Phone:301-986-9144
Mailing Address - Fax:
Practice Address - Street 1:7809 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3523
Practice Address - Country:US
Practice Address - Phone:410-502-1892
Practice Address - Fax:410-614-9246
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013333363A00000X
MDC06691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03132574Medicaid
NY03132574Medicaid