Provider Demographics
NPI:1134510373
Name:LEWIS, SHAKENDA
Entity type:Individual
Prefix:
First Name:SHAKENDA
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 1:7000 FRANKLIN BLVD
Mailing Address - Street 2:625
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1820
Mailing Address - Country:US
Mailing Address - Phone:916-346-9054
Mailing Address - Fax:
Practice Address - Street 1:7000 FRANKLIN BLVD
Practice Address - Street 2:625
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1820
Practice Address - Country:US
Practice Address - Phone:916-346-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor