Provider Demographics
NPI:1659196715
Name:SONG SPARROW PLLC
Entity type:Organization
Organization Name:SONG SPARROW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:434-808-9453
Mailing Address - Street 1:308B S MAIN ST STE 222
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1744
Mailing Address - Country:US
Mailing Address - Phone:434-808-9453
Mailing Address - Fax:
Practice Address - Street 1:308 S MAIN ST STE 222
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1771
Practice Address - Country:US
Practice Address - Phone:434-808-9453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty