Provider Demographics
NPI:1518498062
Name:SPARACINO, HAILEY LYNN (DO)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:LYNN
Last Name:SPARACINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:LYNN LAROCQUE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2323 MEMORIAL AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2652
Mailing Address - Country:US
Mailing Address - Phone:434-200-5200
Mailing Address - Fax:434-200-5201
Practice Address - Street 1:2323 MEMORIAL AVE STE 10
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2652
Practice Address - Country:US
Practice Address - Phone:434-200-5200
Practice Address - Fax:434-200-5201
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-01879207V00000X, 207Q00000X
390200000X
VA0102206898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program