Healthcare Provider Details

I. General information

NPI: 1568154037
Provider Name (Legal Business Name): DETRICK S SNYDER RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 VALLEJO ST
DENVER CO
80221-1363
US

IV. Provider business mailing address

5001 VALLEJO ST
DENVER CO
80221-1363
US

V. Phone/Fax

Practice location:
  • Phone: 720-648-6701
  • Fax:
Mailing address:
  • Phone: 720-648-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86105803
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: