Provider Demographics
NPI:1124897434
Name:LEWIS, SHARON (CNA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SE APACHE AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4060
Mailing Address - Country:US
Mailing Address - Phone:772-634-0390
Mailing Address - Fax:
Practice Address - Street 1:1510 SE APACHE AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4060
Practice Address - Country:US
Practice Address - Phone:772-634-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health