Provider Demographics
NPI:1336426816
Name:LEW, SHIRLEY (TVI/COMS)
Entity Type:Individual
Prefix:MISS
First Name:SHIRLEY
Middle Name:
Last Name:LEW
Suffix:
Gender:F
Credentials:TVI/COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MULBERRY ST APT 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4487
Mailing Address - Country:US
Mailing Address - Phone:917-750-8651
Mailing Address - Fax:
Practice Address - Street 1:80 MULBERRY ST APT 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4487
Practice Address - Country:US
Practice Address - Phone:917-750-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency