Provider Demographics
NPI:1871563221
Name:LEWIS, SHAUNA MARIE (DPM)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 EAST 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:917-608-8013
Mailing Address - Fax:718-629-2427
Practice Address - Street 1:540 E 43RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5716
Practice Address - Country:US
Practice Address - Phone:917-608-8013
Practice Address - Fax:718-629-2427
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005983213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02560525Medicaid
NYPJ2241Medicare PIN
NYU98965Medicare UPIN
NY5609610001Medicare NSC