Provider Demographics
NPI:1104994813
Name:LEWIS, LESLIE SHARP (PA-C)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:SHARP
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 890195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0195
Mailing Address - Country:US
Mailing Address - Phone:336-342-6196
Mailing Address - Fax:
Practice Address - Street 1:233 GILMER ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3809
Practice Address - Country:US
Practice Address - Phone:336-342-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2753337AMedicare ID - Type UnspecifiedMEDICARE
NCP39388Medicare UPIN