Provider Demographics
NPI:1245951045
Name:LEWIS, CHANTELLE
Entity type:Individual
Prefix:MS
First Name:CHANTELLE
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 1:13809 FELIX WILL RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2431
Mailing Address - Country:US
Mailing Address - Phone:813-820-8328
Mailing Address - Fax:
Practice Address - Street 1:13809 FELIX WILL RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2431
Practice Address - Country:US
Practice Address - Phone:813-820-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239788376J00000X
FL237599261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Yes376J00000XNursing Service Related ProvidersHomemaker