Provider Demographics
NPI:1114627320
Name:SPARKS, DESTINI MONAY
Entity Type:Individual
Prefix:
First Name:DESTINI
Middle Name:MONAY
Last Name:SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15408 BEALLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-9546
Mailing Address - Country:US
Mailing Address - Phone:240-722-9909
Mailing Address - Fax:
Practice Address - Street 1:896 SOUTHERN AVE SE APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3454
Practice Address - Country:US
Practice Address - Phone:202-834-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider