Provider Demographics
NPI:1982566733
Name:LEWIS, SHAVONE JASMINE (RRT)
Entity type:Individual
Prefix:MS
First Name:SHAVONE
Middle Name:JASMINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22131 AVON RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2573
Mailing Address - Country:US
Mailing Address - Phone:313-207-8088
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE FL 8
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-452-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4401005393227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered