Healthcare Provider Details

I. General information

NPI: 1689821266
Provider Name (Legal Business Name): JENNIFER BETH SNIADANKO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9610 N METRO PKWY W
PHOENIX AZ
85051-1402
US

IV. Provider business mailing address

10713 N 124TH PL
SCOTTSDALE AZ
85259-5090
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-3001
  • Fax: 602-314-6432
Mailing address:
  • Phone: 480-993-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number005125
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: