Healthcare Provider Details

I. General information

NPI: 1952238057
Provider Name (Legal Business Name): CASSIDY ELAINE LEWIS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12108 OLD LINE CTR
WALDORF MD
20602-2553
US

IV. Provider business mailing address

12108 OLD LINE CTR
WALDORF MD
20602-2553
US

V. Phone/Fax

Practice location:
  • Phone: 301-638-3440
  • Fax: 301-638-3442
Mailing address:
  • Phone: 301-638-3440
  • Fax: 301-638-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: