Provider Demographics
NPI:1851383772
Name:PRINCE, SHERNETTE D (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERNETTE
Middle Name:D
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERNETTE
Other - Middle Name:D
Other - Last Name:LYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9466 GEORGIA AVE # 1295
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1456
Mailing Address - Country:US
Mailing Address - Phone:301-453-2233
Mailing Address - Fax:
Practice Address - Street 1:850 CHISHOLM AVE
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113
Practice Address - Country:US
Practice Address - Phone:301-453-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2552106OtherUHC PROVIDER NUMBER
MD3964337OtherAETNA CAPITATED
MD8144405OtherMAMSI PRIMARY CARE
MD16589OtherJHHC PROVIDER NUMBER
MDP16842OtherCAREFIRST MPOS
MD2144405OtherMAMSI SPECIALIST
MDP00315275OtherRR MEDICARE
MD646624-01OtherCAREFIRST MD RENDERING
MD408287700Medicaid
MD7605-0075OtherCAREFIRST BLUECHOICE
MD7653704OtherAETNA FEE FOR SERVICE
MD8640947OtherCIGNA PIN
MD408287700Medicaid
MD8640947OtherCIGNA PIN