Provider Demographics
NPI:1184727653
Name:SPARKS, CHERYL (ANP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4988 STATE HIGHWAY 30
Mailing Address - Street 2:AMSTERDAM MEMORIAL HEALTH CENTER
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7520
Mailing Address - Country:US
Mailing Address - Phone:518-843-4356
Mailing Address - Fax:518-843-6513
Practice Address - Street 1:4988 STATE HIGHWAY 30
Practice Address - Street 2:AMSTERDAM MEMORIAL HEALTH CENTER
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7520
Practice Address - Country:US
Practice Address - Phone:518-843-4356
Practice Address - Fax:518-843-6513
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3034691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
547811OtherBLUE CHOICE
10001883OtherCDPHP
08230OtherMVP
NY01170667Medicaid
000401398001OtherDSNENY
NYJ400009518Medicare PIN
E23639Medicare UPIN