Provider Demographics
NPI:1568970234
Name:LEWIS, MAUREASHA
Entity Type:Individual
Prefix:
First Name:MAUREASHA
Middle Name:
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 1:11715 SE 57TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-6011
Mailing Address - Country:US
Mailing Address - Phone:352-875-1795
Mailing Address - Fax:
Practice Address - Street 1:11715 SE 57TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-6011
Practice Address - Country:US
Practice Address - Phone:352-875-1795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health