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NPI Code Detail

MEDICARE: DEJA LEWIS

MEDICARE: DEJA 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1811830078
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEJA LEWIS
Provider Business Mailing Address
First Line : 5004 TOWERGATE DR APT 12
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-2435
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 280 CHARLOIS BLVD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-1588
Country : US
Telephone Number : 704-799-6824
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ DEJA LEWIS ” Practice Location

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