Healthcare Provider Details

I. General information

NPI: 1639757909
Provider Name (Legal Business Name): DANIELLE SHERYL-LEE NELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE SHERYL-LEE REID MD

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 US-61 N
VICKSBURG MS
39183
US

IV. Provider business mailing address

2100 US-61 N
VICKSBURG MS
39183
US

V. Phone/Fax

Practice location:
  • Phone: 601-883-5000
  • Fax:
Mailing address:
  • Phone: 601-883-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34428
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: