Provider Demographics
NPI:1518082551
Name:SPORN, STEPHEN (ND)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:SPORN
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 EVANS ST APT 6
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5633
Mailing Address - Country:US
Mailing Address - Phone:206-678-3908
Mailing Address - Fax:
Practice Address - Street 1:317 EVANS STREET, # 6
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5633
Practice Address - Country:US
Practice Address - Phone:206-678-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR537175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath