Provider Demographics
NPI:1992720460
Name:LEWIS, SANDRA A (CNM)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:HOULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1815 S. CLINTON AVENUE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5723
Mailing Address - Country:US
Mailing Address - Phone:585-244-3430
Mailing Address - Fax:585-244-2202
Practice Address - Street 1:1265 VISCAYA PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3237
Practice Address - Country:US
Practice Address - Phone:239-574-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006330367A00000X
NYF001007367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02226231Medicaid
NYJ400071129/BA0017Medicare PIN
NYRA5827Medicare PIN
NY02226231Medicaid