Healthcare Provider Details

I. General information

NPI: 1871992768
Provider Name (Legal Business Name): SAMANTHA LEWANDOWSKI AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 COTTAGE ST STE E
SANFORD ME
04073
US

IV. Provider business mailing address

312 COTTAGE ST STE E
SANFORD ME
04073-1835
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-8668
  • Fax: 603-436-4499
Mailing address:
  • Phone: 207-324-8483
  • Fax: 207-490-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP2755
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: