Provider Demographics
NPI:1902675929
Name:LEWIS, CHELLSY
Entity Type:Individual
Prefix:
First Name:CHELLSY
Middle Name:
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:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:FL
Mailing Address - Zip Code:32187-0021
Mailing Address - Country:US
Mailing Address - Phone:386-336-3150
Mailing Address - Fax:
Practice Address - Street 1:116 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:FL
Practice Address - Zip Code:32187
Practice Address - Country:US
Practice Address - Phone:386-336-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL329715172A00000X, 253Z00000X, 347C00000X, 385HR2050X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp