Healthcare Provider Details

I. General information

NPI: 1174226856
Provider Name (Legal Business Name): SHAPIRA J LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 SHORE DR
INDIANAPOLIS IN
46254-2608
US

IV. Provider business mailing address

901 S AUBURN ST
INDIANAPOLIS IN
46241-2301
US

V. Phone/Fax

Practice location:
  • Phone: 317-340-2599
  • Fax:
Mailing address:
  • Phone: 317-997-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: