Provider Demographics
NPI:1245778257
Name:SPARKS, MONICA (PA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:GUTBROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12420 MILESTONE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7111
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2330
Practice Address - Street 1:630 E RIVER ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5902
Practice Address - Country:US
Practice Address - Phone:440-329-7450
Practice Address - Fax:440-329-5814
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004980RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant