Healthcare Provider Details

I. General information

NPI: 1427455690
Provider Name (Legal Business Name): TAMICKA LEWIS I HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS TAMICKA LEWIS

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BLUERIDGE AVE SILVERSPRING SUITE 301
SILVER SPRING DC
20019-2001
US

IV. Provider business mailing address

2401 BLUERIDGE AVE 301
SILVER SPRING DC
20019
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-0466
  • Fax: 301-933-2007
Mailing address:
  • Phone: 202-292-8592
  • Fax: 301-933-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2002659
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2002659
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA6659
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: