Healthcare Provider Details

I. General information

NPI: 1073999579
Provider Name (Legal Business Name): KELLY M. LEWIS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N 87TH ST
SCOTTSDALE AZ
85257-2922
US

IV. Provider business mailing address

5202 E MAIN ST SUITE #105
MESA AZ
85205-8038
US

V. Phone/Fax

Practice location:
  • Phone: 480-429-0026
  • Fax: 480-429-0028
Mailing address:
  • Phone: 480-218-1328
  • Fax: 480-218-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA9474
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: