Healthcare Provider Details

I. General information

NPI: 1740198803
Provider Name (Legal Business Name): MISS SHERRY SHAWONDA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 BROOKWOOD ESTATES DR
JACKSON MS
39272-5661
US

IV. Provider business mailing address

459 BROOKWOOD ESTATES DR
JACKSON MS
39272-5661
US

V. Phone/Fax

Practice location:
  • Phone: 601-213-7773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: