Provider Demographics
NPI:1588378715
Name:LEVI, LORI (PA-C)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LEVI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18205 BISCAYNE BOULEVARD
Mailing Address - Street 2:S. 2217
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:305-935-9922
Mailing Address - Fax:
Practice Address - Street 1:18205 BISCAYNE BOULEVARD
Practice Address - Street 2:S. 2217
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160
Practice Address - Country:US
Practice Address - Phone:305-935-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant