Healthcare Provider Details

I. General information

NPI: 1659166411
Provider Name (Legal Business Name): SPARKLY LIFE HEALTH COACHING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 WESTRIDGE DR STE 1
HOCKESSIN DE
19707-2304
US

IV. Provider business mailing address

808 WESTRIDGE DR STE 1
HOCKESSIN DE
19707-2304
US

V. Phone/Fax

Practice location:
  • Phone: 302-540-3870
  • Fax: 302-540-3870
Mailing address:
  • Phone: 302-540-3870
  • Fax: 302-540-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PIALEE ROY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 302-540-3870