Healthcare Provider Details

I. General information

NPI: 1063479723
Provider Name (Legal Business Name): SHERYLL ANGELA VINCENT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERYLL ANGELA FLETCHER-VINCENT MD

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 WATKINS DR STE A
JACKSON MS
39206-2034
US

IV. Provider business mailing address

5440 WATKINS DR STE A
JACKSON MS
39206-2034
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-3636
  • Fax: 601-982-5335
Mailing address:
  • Phone: 601-981-3636
  • Fax: 601-982-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number14014
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: