Healthcare Provider Details

I. General information

NPI: 1801884150
Provider Name (Legal Business Name): MICHELE ELIZABETH SPROSTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE ELIZABETH OVERTON MD

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5833 HARBOR VIEW BLVD STE B
SUFFOLK VA
23435-3760
US

IV. Provider business mailing address

5833 HARBOR VIEW BLVD STE B
SUFFOLK VA
23435-3760
US

V. Phone/Fax

Practice location:
  • Phone: 757-337-4018
  • Fax:
Mailing address:
  • Phone: 757-337-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA89515
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01066050A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101280768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: