Provider Demographics
NPI:1164245148
Name:LEWIS, SHANTIQUA QUASHAY
Entity type:Individual
Prefix:
First Name:SHANTIQUA
Middle Name:QUASHAY
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 1:66 MARIA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-5731
Mailing Address - Country:US
Mailing Address - Phone:585-441-8602
Mailing Address - Fax:
Practice Address - Street 1:66 MARIA ST APT 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-5731
Practice Address - Country:US
Practice Address - Phone:585-441-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350181164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse