Healthcare Provider Details

I. General information

NPI: 1790622348
Provider Name (Legal Business Name): TI'AESHA K LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIAESHA K MAXWELL RN,LPN

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8657 QUEENSWAY CT
WHITE PLAINS MD
20695-4429
US

IV. Provider business mailing address

8657 QUEENSWAY CT
WHITE PLAINS MD
20695-4429
US

V. Phone/Fax

Practice location:
  • Phone: 240-579-8072
  • Fax:
Mailing address:
  • Phone: 240-579-8072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number0002091381
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number9644264
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number9644264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: