Provider Demographics
NPI:1184315855
Name:LEWIS, SHASTA
Entity type:Individual
Prefix:MRS
First Name:SHASTA
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:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OH
Mailing Address - Zip Code:45613-0004
Mailing Address - Country:US
Mailing Address - Phone:740-727-8340
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 4
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OH
Practice Address - Zip Code:45613-0004
Practice Address - Country:US
Practice Address - Phone:740-727-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker