Provider Demographics
NPI:1659861292
Name:LEWIS, SAMEERAH YASMEENA
Entity Type:Individual
Prefix:
First Name:SAMEERAH
Middle Name:YASMEENA
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 1:880 E 232ND ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2555
Mailing Address - Country:US
Mailing Address - Phone:216-659-0247
Mailing Address - Fax:
Practice Address - Street 1:880 E 232ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2555
Practice Address - Country:US
Practice Address - Phone:216-659-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379813820501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156557Medicaid