Healthcare Provider Details

I. General information

NPI: 1386229524
Provider Name (Legal Business Name): SHANNON SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 ATLANTIC AVE
LONG BEACH CA
90807-2803
US

IV. Provider business mailing address

2501 E 4TH ST APT 4
LONG BEACH CA
90814-3506
US

V. Phone/Fax

Practice location:
  • Phone: 562-321-1915
  • Fax:
Mailing address:
  • Phone: 714-478-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: