MEDICARE: SHERYL LEE

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	1223G0001X	General Practice Dentistry	059232	NY

General Provider Information

NPI Number	:	1144680406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL LEE

Provider Business Mailing Address
First Line	:	273 DRIGGS AVE APT 2R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-3914
Country	:	US
Telephone Number	:	732-593-7187
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 E 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4716
Country	:	US
Telephone Number	:	718-338-4177
Fax Number	:

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

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	03/17/2018

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