Provider Demographics
NPI:1487145868
Name:SPARROW, SHAYNE LEON (PARAMEDIC)
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:LEON
Last Name:SPARROW
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:SHAYNE
Other - Middle Name:LEON
Other - Last Name:STOCKTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PARAMEDIC
Mailing Address - Street 1:207 TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:VANDENBERG AFB
Mailing Address - State:CA
Mailing Address - Zip Code:93437-1437
Mailing Address - Country:US
Mailing Address - Phone:504-430-2005
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE ATTN: MCHJ-CLQ-C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
M0983833146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic