Healthcare Provider Details

I. General information

NPI: 1326074352
Provider Name (Legal Business Name): JUDY K SNYDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 W LINCOLN AVE
GOSHEN IN
46526-5907
US

IV. Provider business mailing address

1930 W LINCOLN AVE
GOSHEN IN
46526-5907
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-2161
  • Fax: 574-534-3887
Mailing address:
  • Phone: 574-534-2161
  • Fax: 574-534-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01028687A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01028687A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: