Healthcare Provider Details

I. General information

NPI: 1942067368
Provider Name (Legal Business Name): PAULA MICHELLE LEWIS ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 WARD PKWY
MELBOURNE FL
32904-3636
US

IV. Provider business mailing address

6565 WARD PKWY
MELBOURNE FL
32904-3636
US

V. Phone/Fax

Practice location:
  • Phone: 904-472-6050
  • Fax:
Mailing address:
  • Phone: 904-472-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number793225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: