Provider Demographics
NPI:1700571338
Name:COOPER-LEWIS, SHARON D (LIFE & HEALTH)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:D
Last Name:COOPER-LEWIS
Suffix:
Gender:F
Credentials:LIFE & HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 WINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4655
Mailing Address - Country:US
Mailing Address - Phone:757-239-1100
Mailing Address - Fax:
Practice Address - Street 1:2658 WINGFIELD RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4655
Practice Address - Country:US
Practice Address - Phone:757-239-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
251B00000X, 347C00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No172A00000XOther Service ProvidersDriver
No251B00000XAgenciesCase Management
No347C00000XTransportation ServicesPrivate Vehicle