Basic Information
| Provider Information | |||||||||
| NPI: | 1528130721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | DANYA | ||||||||
| MiddleName: | KRYSTYNA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEWIS | ||||||||
| OtherFirstName: | DANUTA | ||||||||
| OtherMiddleName: | K | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465888 | ||||||||
| FaxNumber: | 7574465918 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 FAIRFAX AVE | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465888 | ||||||||
| FaxNumber: | 7574465918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 06/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0101261270 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1528130721 | 01 | VA | MAGELLAN HEALTHCARE | OTHER | 1528130721 | 01 | VA | ANTHEM BEHAVIORAL HEALTH | OTHER | 1528130721 | 01 | TRICARE/CHAMPUS | OTHER | 1528130721 | 05 | NC | MEDICAID | 1528130721 | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | 1528130721 | 01 | VA | OPTIMA BEHAVIORAL HEALTH | OTHER | 1528130721 | 01 | VA | HUMANA | OTHER | 1528130721 | 01 | VA | CORVEL | OTHER | 1528130721 | 01 | VA | BEACON HEALTH OPTIONS | OTHER | 1528130721 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 1528130721 | 01 | VA | UNITED BEHAVIORAL HEALTH | OTHER | 1528130721 | 05 | VA | MEDICAID | 1528130721 | 01 | VA | MULTIPLAN | OTHER | 1528130721 | 01 | VA | CIGNA BEHAVIORAL HEALTH | OTHER | 1528130721 | 01 | VA | USA MANAGED CARE | OTHER |