Provider Demographics
NPI:1508574070
Name:LEWIS, SHANNA MAURICE
Entity Type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:MAURICE
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 1:5703 WINDLESTRAW DR
Mailing Address - Street 2:APT 33
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:910-354-6207
Mailing Address - Fax:
Practice Address - Street 1:5703 WINDLESTRAW DR
Practice Address - Street 2:APT 33
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:910-354-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle