Healthcare Provider Details

I. General information

NPI: 1073008298
Provider Name (Legal Business Name): MICHELLE T SNYDER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE T HACK DO

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 NW 33RD ST STE 101
CORAL SPRINGS FL
33065-4000
US

IV. Provider business mailing address

86 W UNDERWOOD ST STE 202
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-9220
  • Fax: 954-752-1549
Mailing address:
  • Phone: 407-649-6876
  • Fax: 407-872-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS18149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: