Individual
MS. KELLY SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1 GUSTAVE L LEVY PL, BOX 1104, NEW YORK, NY 10029-6500
(212) 659-9300
Mailing address
166 E 91ST ST APT 4B, NEW YORK, NY 10128-2003
(440) 759-1220
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
006957
NY
Other
Enumeration date
12/08/2011
Last updated
12/08/2011
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