MEDICARE: DR. SHERYLL ANGELA VINCENT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	14014	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063479723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERYLL ANGELA VINCENT MD

Provider Business Mailing Address
First Line	:	5440 WATKINS DR
Second Line	:	STE A
City	:	JACKSON
State	:	MS
Zip	:	39206-2034
Country	:	US
Telephone Number	:	601-981-3636
Fax Number	:	601-982-5335

Provider Business Practice Location Address
First Line	:	5440 WATKINS DR
Second Line	:	STE A
City	:	JACKSON
State	:	MS
Zip	:	39206-2034
Country	:	US
Telephone Number	:	601-981-3636
Fax Number	:	601-982-5335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	06/15/2010

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