MEDICARE: GRACE-ANN 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	103K00000X	Behavior Analyst	1-22-57974	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982106423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE-ANN LEWIS

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD STE 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	844-854-1116
Fax Number	:	305-846-9711

Provider Business Practice Location Address
First Line	:	1160 S SEMORAN BLVD STE AB
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1461
Country	:	US
Telephone Number	:	407-537-7522
Fax Number	:

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

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	02/01/2023

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Directions to “ GRACE-ANN LEWIS ” Practice Location

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