MEDICARE: ROBERT L SPARACIO PA C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	001354	CT
2	363AM0700X	Medical Physician Assistant	012382	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124031240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L SPARACIO PA C

Provider Business Mailing Address
First Line	:	PO BOX 11090
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92685-1090
Country	:	US
Telephone Number	:	562-809-3548
Fax Number	:

Provider Business Practice Location Address
First Line	:	1296 NORTH AVE
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-2603
Country	:	US
Telephone Number	:	914-235-8224
Fax Number	:	914-235-6940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/21/2022

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Directions to “ ROBERT L SPARACIO PA C” Practice Location

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