Provider Demographics
NPI:1952288680
Name:SPARROW, SHELLY LYNN
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:SPARROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:LYNN
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 N CRUSEY ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7100
Mailing Address - Country:US
Mailing Address - Phone:907-671-3862
Mailing Address - Fax:
Practice Address - Street 1:777 N CRUSEY ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7100
Practice Address - Country:US
Practice Address - Phone:907-671-3862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator