Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 0103300979 | VA |
Y | 213ES0131X | Foot Surgery | N006220-1 | NY |
NPI | 1326251455 |
---|---|
Provider Name | Dr. Pamela Michelle Sparks |
First Address | Syracuse, NY 13212-3627 |
Second Address | Syracuse, NY 13212-3627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 23/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2960630 | (05) | NY |