Individual
SPARKLE STARR CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9 DAISY ST, ROCHESTER, NY 14615-3610
(585) 208-9280
Mailing address
9 DAISY ST, ROCHESTER, NY 14615-3610
(585) 208-9280
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
670358397
NY
343900000X
Non-emergency Medical Transport (VAN)
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05097269
PROVIDER ID
NY
05
—
05097269
—
NY
Enumeration date
05/11/2020
Last updated
05/11/2020
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