Healthcare Provider Details

I. General information

NPI: 1255831343
Provider Name (Legal Business Name): DYLAN SNYDER HCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1697 OLD HIGHWAY 135 NE
CORYDON IN
47112-2010
US

IV. Provider business mailing address

1697 OLD HIGHWAY 135 NE
CORYDON IN
47112-2010
US

V. Phone/Fax

Practice location:
  • Phone: 812-596-4543
  • Fax:
Mailing address:
  • Phone: 812-596-4543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001497A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: