Provider Demographics
NPI:1326251455
Name:SPARKS, PAMELA MICHELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MICHELLE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S BAY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3627
Mailing Address - Country:US
Mailing Address - Phone:315-458-1777
Mailing Address - Fax:315-458-9661
Practice Address - Street 1:514 S BAY RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3627
Practice Address - Country:US
Practice Address - Phone:315-458-1777
Practice Address - Fax:315-458-9661
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300979213ES0103X
NYN006220-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2960630Medicaid
NY598891Medicare PIN