Provider Demographics
NPI:1922621804
Name:GARY - LEWIS, SHANDRA (BIRTH DOULA)
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:
Last Name:GARY - LEWIS
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 DODGE ST APT 803
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-2530
Mailing Address - Country:US
Mailing Address - Phone:716-440-7377
Mailing Address - Fax:
Practice Address - Street 1:564 DODGE ST APT 803
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-2530
Practice Address - Country:US
Practice Address - Phone:716-440-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula