Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT1747 | FL |
Y | 213ES0000X | Sports Medicine | PT1747 | FL |
NPI | 1154956308 |
---|---|
Provider Name | Suzanne Lewis |
First Address | New Smyrna Beach, FL 32168-7318 |
Second Address | New Smyrna Beach, FL 32168-7318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2020 |
Last Update Date | 09/03/2020 |