Provider Demographics
NPI:1053804682
Name:LEWIS, SANDRA KAYE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAYE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2407
Mailing Address - Country:US
Mailing Address - Phone:804-931-2313
Mailing Address - Fax:804-715-6118
Practice Address - Street 1:124 ESSEX RD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2407
Practice Address - Country:US
Practice Address - Phone:804-931-2313
Practice Address - Fax:804-715-6118
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY