Provider Demographics
NPI:1255021036
Name:SPARKMAN, NAJAY JAHIEM I
Entity type:Individual
Prefix:MR
First Name:NAJAY
Middle Name:JAHIEM
Last Name:SPARKMAN
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:JAHIEM
Other - Last Name:SPARKMAN
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3730 W BROADWAY AVE UNIT 230
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3679
Mailing Address - Country:US
Mailing Address - Phone:612-224-1964
Mailing Address - Fax:
Practice Address - Street 1:3730 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-3671
Practice Address - Country:US
Practice Address - Phone:612-224-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist