Healthcare Provider Details

I. General information

NPI: 1154638658
Provider Name (Legal Business Name): VANESSA SPARTA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA WIESZUN

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9714 HEALTHWAY DR
BERLIN MD
21811-1154
US

IV. Provider business mailing address

11740 WINDING CREEK DR
BERLIN MD
21811-2907
US

V. Phone/Fax

Practice location:
  • Phone: 410-641-3340
  • Fax:
Mailing address:
  • Phone: 973-271-2882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC04309
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: