Provider Demographics
NPI:1497706337
Name:LEWIS, BRENDA ANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:BARACKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:735 PRIMERA BLVD
Mailing Address - Street 2:SUITE #135
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2112
Mailing Address - Country:US
Mailing Address - Phone:407-321-0085
Mailing Address - Fax:407-328-7658
Practice Address - Street 1:735 PRIMERA BLVD
Practice Address - Street 2:SUITE #135
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2112
Practice Address - Country:US
Practice Address - Phone:407-321-0085
Practice Address - Fax:407-328-7658
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics