Healthcare Provider Details

I. General information

NPI: 1134067838
Provider Name (Legal Business Name): CHRISTINA AMANDA LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 E 212TH ST
BRONX NY
10469-2408
US

IV. Provider business mailing address

1116 E 212TH ST
BRONX NY
10469-2408
US

V. Phone/Fax

Practice location:
  • Phone: 917-374-0179
  • Fax:
Mailing address:
  • Phone: 917-374-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number749665
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: