Provider Demographics
NPI:1538312608
Name:LEWIS, SHARENE R (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHARENE
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9151 115TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3138
Mailing Address - Country:US
Mailing Address - Phone:917-617-3733
Mailing Address - Fax:718-441-0474
Practice Address - Street 1:9151 115TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3138
Practice Address - Country:US
Practice Address - Phone:917-617-3733
Practice Address - Fax:718-441-0474
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 11747-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist