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General NPI Number Information
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NPI Number | 1154148245
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Entity Type | Individual
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Provider Name | MARY SHARDAE LEWIS L.AC
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Gender | Female
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Dates
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Enumeration Date | 09/20/2024
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Last Update Date | 09/21/2024
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Provider Practice Location Address
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Address Line | 683 OLD MILL RD
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City | MILLERSVILLE
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State | MD
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Zip | 21108-1326
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Country | US
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Telephone | 410-729-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 703 DAWN PL APT C
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City | LANTANA
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State | FL
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Zip | 33462-1615
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Country | US
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Telephone | 954-939-9196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U03140
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License Number State | MD
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