Healthcare Provider Details

I. General information

NPI: 1730967902
Provider Name (Legal Business Name): SHAWN SNYDER CSFA, LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29253 US HIGHWAY 19 N
CLEARWATER FL
33761-2102
US

IV. Provider business mailing address

29253 US HIGHWAY 19 N
CLEARWATER FL
33761-2102
US

V. Phone/Fax

Practice location:
  • Phone: 727-313-4764
  • Fax: 727-313-4764
Mailing address:
  • Phone: 727-313-4764
  • Fax: 727-313-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number140639
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0136000269
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: