Healthcare Provider Details

I. General information

NPI: 1770024796
Provider Name (Legal Business Name): TAMIKA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 NW 159TH DR
MIAMI FL
33169-5808
US

IV. Provider business mailing address

1160 NW 159TH DR
MIAMI FL
33169-5808
US

V. Phone/Fax

Practice location:
  • Phone: 305-623-4438
  • Fax: 305-623-4440
Mailing address:
  • Phone: 305-623-4438
  • Fax: 305-623-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number020115800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: