Healthcare Provider Details

I. General information

NPI: 1992295463
Provider Name (Legal Business Name): CLARAJEAN SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 NW LAKE WHITNEY PL STE 103
PORT SAINT LUCIE FL
34986-1605
US

IV. Provider business mailing address

525 NW LAKE WHITNEY PL STE 103
PORT SAINT LUCIE FL
34986-1605
US

V. Phone/Fax

Practice location:
  • Phone: 772-529-3267
  • Fax: 772-337-8165
Mailing address:
  • Phone: 772-529-3267
  • Fax: 772-337-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberIMT2328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: