Provider Demographics
NPI:1841717543
Name:LEWIS, SHEVONE C
Entity type:Individual
Prefix:
First Name:SHEVONE
Middle Name:C
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 1:6306 S MACDILL AVE APT 429
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-5072
Mailing Address - Country:US
Mailing Address - Phone:347-267-2943
Mailing Address - Fax:
Practice Address - Street 1:7383 W GRANT RANCH BLVD APT 1725
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2668
Practice Address - Country:US
Practice Address - Phone:347-267-2943
Practice Address - Fax:347-267-2943
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1643039163W00000X
FL11036110363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse