Provider Demographics
NPI:1346835311
Name:LEWIS, BRIANA JANIQUE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:JANIQUE
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 1:5455 68TH WAY N APT 3206
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3012
Mailing Address - Country:US
Mailing Address - Phone:727-263-9817
Mailing Address - Fax:
Practice Address - Street 1:5455 68TH WAY N APT 3206
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-3012
Practice Address - Country:US
Practice Address - Phone:727-537-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty