Healthcare Provider Details

I. General information

NPI: 1649378159
Provider Name (Legal Business Name): JAN MELINDA SNYDER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAN SNYDER PEREA PHD

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 C NW 41ST STREET
GAINESVILLE FL
32606
US

IV. Provider business mailing address

2531 C NW 41ST STREET
GAINESVILLE FL
32606
US

V. Phone/Fax

Practice location:
  • Phone: 352-372-2206
  • Fax: 352-377-6662
Mailing address:
  • Phone: 352-372-2206
  • Fax: 352-377-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4507
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3642
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: