MEDICARE: CYNTHIA 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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1891044871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LEWIS

Provider Business Mailing Address
First Line	:	11208 SCOTCHWOOD DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7152
Country	:	US
Telephone Number	:	813-376-6763
Fax Number	:

Provider Business Practice Location Address
First Line	:	11208 SCOTCHWOOD DR.
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-2034
Country	:	US
Telephone Number	:	813-376-6763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	12/30/2014

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