Individual
MS. SHANTEA LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2403 DENNIS ST, COPPERAS COVE, TX 76522-4828
(404) 519-3796
Mailing address
2403 DENNIS ST, COPPERAS COVE, TX 76522-4828
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
03/05/2020
Last updated
03/05/2020
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