Provider Demographics
NPI:1760748115
Name:LEWIS, ALEXANDRA (MS, RD, LD/N)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 FORESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-0043
Mailing Address - Country:US
Mailing Address - Phone:904-625-5357
Mailing Address - Fax:
Practice Address - Street 1:74 FORESTVIEW LN
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0043
Practice Address - Country:US
Practice Address - Phone:904-625-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6225133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered