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General NPI Number Information
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NPI Number | 1255258836
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Entity Type | Individual
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Provider Name | RYAN SPARKS
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Gender | Male
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Dates
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Enumeration Date | 07/02/2026
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Last Update Date | 07/02/2026
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Provider Practice Location Address
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Address Line | 7 MANCHESTER DR
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City | MASSAPEQUA
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State | NY
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Zip | 11758-1019
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Country | US
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Telephone | 516-531-3759
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Fax |
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Provider Business Mailing Address
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Address Line | 6942 199TH ST
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-4024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P138939
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License Number State | NY
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