Provider Demographics
NPI:1144463175
Name:LEWIS, DAPHNE
Entity type:Individual
Prefix:MS
First Name:DAPHNE
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 1:8424 SHERATON DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2825
Mailing Address - Country:US
Mailing Address - Phone:954-540-8221
Mailing Address - Fax:954-416-6261
Practice Address - Street 1:8424 SHERATON DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2825
Practice Address - Country:US
Practice Address - Phone:954-540-8221
Practice Address - Fax:954-416-6261
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10-1955-GH177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging