MEDICARE: SADE NICOLE LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WV0202X	Vehicle Modifications Contractor
2	172A00000X	Driver

General Provider Information

NPI Number	:	1205787850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADE NICOLE LEWIS

Provider Business Mailing Address
First Line	:	3364 HARRISON RD STE 385
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-4351
Country	:	US
Telephone Number	:	334-224-7128
Fax Number	:

Provider Business Practice Location Address
First Line	:	3364 HARRISON RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-4351
Country	:	US
Telephone Number	:	334-224-7128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ SADE NICOLE LEWIS ” Practice Location

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