Provider Demographics
NPI:1508463399
Name:LEWIS, SHANIA BREEANN
Entity Type:Individual
Prefix:MS
First Name:SHANIA
Middle Name:BREEANN
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 1:50194 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3136
Mailing Address - Country:US
Mailing Address - Phone:586-991-6596
Mailing Address - Fax:
Practice Address - Street 1:50194 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3136
Practice Address - Country:US
Practice Address - Phone:586-991-6596
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent