Individual
LEWDY MATIAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
916 11TH ST, SAINT CLOUD, FL 34769-3754
(321) 805-0282
Mailing address
916 11TH STREET, SAINT CLOUD, FL 34769-3754
(321) 805-0282
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003627100
—
FL
Enumeration date
10/31/2013
Last updated
07/21/2022
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