Provider Demographics
NPI:1518676063
Name:LEWIS, LYNETTE SABITA (MSED)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:SABITA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 98TH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2258
Mailing Address - Country:US
Mailing Address - Phone:929-354-3290
Mailing Address - Fax:
Practice Address - Street 1:8635 98TH ST APT 2R
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2258
Practice Address - Country:US
Practice Address - Phone:929-354-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMT86965PMedicaid