Healthcare Provider Details

I. General information

NPI: 1720001852
Provider Name (Legal Business Name): JULIE D SCHNEIDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 CLYDE MORRIS BLVD SUITE 240
ORMOND BEACH FL
32174-3181
US

IV. Provider business mailing address

PO BOX 730729
ORMOND BEACH FL
32173-0729
US

V. Phone/Fax

Practice location:
  • Phone: 386-231-6172
  • Fax: 386-676-6173
Mailing address:
  • Phone: 386-671-4500
  • Fax: 386-672-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME95441
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME95441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: