Provider Demographics
NPI:1962769414
Name:LEWIS, AYANNA ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:AYANNA
Middle Name:ELAINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1551
Mailing Address - Country:US
Mailing Address - Phone:516-632-3000
Mailing Address - Fax:
Practice Address - Street 1:2209 MERRICK RD STE 100
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4770
Practice Address - Country:US
Practice Address - Phone:516-546-5000
Practice Address - Fax:516-546-0596
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140273207RG0100X, 207RG0100X
NY298519207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology