Individual
KENDRA D LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
67 DIANA DR, MASTIC BEACH, NY 11951-6308
(631) 235-5091
Mailing address
67 DIANA DR, MASTIC BEACH, NY 11951-6308
(631) 235-5091
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932801669
—
NY
Enumeration date
03/20/2023
Last updated
12/26/2023
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