Provider Demographics
NPI:1801884150
Name:SPROSTY, MICHELE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ELIZABETH
Last Name:SPROSTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:ELIZABETH
Other - Last Name:OVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5833 HARBOR VIEW BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3760
Mailing Address - Country:US
Mailing Address - Phone:757-337-4018
Mailing Address - Fax:
Practice Address - Street 1:5833 HARBOR VIEW BLVD STE B
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3760
Practice Address - Country:US
Practice Address - Phone:757-337-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89515207Q00000X
IN01066050A207Q00000X
VA0101280768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine