Provider Demographics
NPI:1568590826
Name:LEWINS, SHANI NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANI
Middle Name:NICOLE
Last Name:LEWINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BOND ST # 286
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2045
Mailing Address - Country:US
Mailing Address - Phone:516-708-1490
Mailing Address - Fax:
Practice Address - Street 1:300 STEAMBOAT RD
Practice Address - Street 2:USMMA, PATTEN CLINIC
Practice Address - City:KINGS POINT
Practice Address - State:NY
Practice Address - Zip Code:11024-1634
Practice Address - Country:US
Practice Address - Phone:516-773-5331
Practice Address - Fax:516-773-5341
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12900OtherDENTAL LICENSE
NC7396OtherDENTAL LICENSE
DCDEN1000246OtherDENTAL LICENSE