MEDICARE: LAKEASHI 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	311ZA0620X	Adult Care Home Facility	109776	FL

General Provider Information

NPI Number	:	1952833477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKEASHI LEWIS

Provider Business Mailing Address
First Line	:	11910 NW 19TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33167-2701
Country	:	US
Telephone Number	:	786-521-4082
Fax Number	:

Provider Business Practice Location Address
First Line	:	11910 N.W 19 AVE. #A
Second Line	:
City	:	MIAMI
State	:	FL.
Zip	:	33167
Country	:	UM
Telephone Number	:	786-521-4082
Fax Number	:

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

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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Directions to “ LAKEASHI LEWIS ” Practice Location

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