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NPI Code Detail

MEDICARE: DAVONTAY LEWIS

MEDICARE: DAVONTAY LEWIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1417789892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVONTAY LEWIS
Provider Business Mailing Address
First Line : 6708 MAPLEBROOK LN
Second Line :
City : FLINT
State : MI
Zip : 48507-4189
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1321 S LINDEN RD
Second Line :
City : FLINT
State : MI
Zip : 48532-3444
Country : US
Telephone Number : 810-496-4955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2024
Last Update Date : 08/15/2024

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Directions to “ DAVONTAY LEWIS ” Practice Location

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