Provider Demographics
NPI:1235718818
Name:LEWIS, JYNASYS A
Entity Type:Individual
Prefix:
First Name:JYNASYS
Middle Name:A
Last Name:LEWIS
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 1:1300 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6684
Mailing Address - Country:US
Mailing Address - Phone:919-273-6948
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN CT
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-6684
Practice Address - Country:US
Practice Address - Phone:919-273-6948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000037289493106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC73003565OtherUNITED HEALTHCARE