Healthcare Provider Details

I. General information

NPI: 1134853377
Provider Name (Legal Business Name): JACKLYN SNIDER AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

15770 COUNTY ROAD 565A
CLERMONT FL
34711-8995
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-1000
  • Fax:
Mailing address:
  • Phone: 815-742-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: