Provider Demographics
NPI:1497220198
Name:SPARKS, SHERRY RENE
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:RENE
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 1:4240 BELVIDERE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-1383
Mailing Address - Country:US
Mailing Address - Phone:586-260-0060
Mailing Address - Fax:313-638-1086
Practice Address - Street 1:4240 BELVIDERE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-1383
Practice Address - Country:US
Practice Address - Phone:586-260-0060
Practice Address - Fax:313-638-1086
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)