MEDICARE: DR. SHERI YOLANDA PRENTISS M.D., M.P.H.

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	036-091921	IL

General Provider Information

NPI Number	:	1073616280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERI YOLANDA PRENTISS M.D., M.P.H.

Provider Business Mailing Address
First Line	:	1507 E 53RD ST
Second Line	:	# 274
City	:	CHICAGO
State	:	IL
Zip	:	60615-4573
Country	:	US
Telephone Number	:	847-602-2277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2238 N CYPRESS BEND DR
Second Line	:	APT 502
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-5618
Country	:	US
Telephone Number	:	847-602-2277
Fax Number	:

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	03/21/2016

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