Provider Demographics
NPI:1952663569
Name:LEWIS, SHEVON NARETTVA (MSED)
Entity Type:Individual
Prefix:
First Name:SHEVON
Middle Name:NARETTVA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 SHEPHERD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2322
Mailing Address - Country:US
Mailing Address - Phone:718-496-4828
Mailing Address - Fax:347-787-0272
Practice Address - Street 1:446 SHEPHERD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2322
Practice Address - Country:US
Practice Address - Phone:718-496-4828
Practice Address - Fax:347-787-0272
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568048051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist