Provider Demographics
NPI:1366782633
Name:LEWIS, AMANDA (LAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 BUDDHA HWY
Mailing Address - Street 2:
Mailing Address - City:SIDNEY CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13839-3180
Mailing Address - Country:US
Mailing Address - Phone:607-768-5958
Mailing Address - Fax:
Practice Address - Street 1:1121 UPPER FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1116
Practice Address - Country:US
Practice Address - Phone:607-768-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003813171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist