Healthcare Provider Details

I. General information

NPI: 1295112209
Provider Name (Legal Business Name): RODNEY BRANDON SNEATH RT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

725 E 71ST ST
INDIANAPOLIS IN
46220-1065
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-3456
  • Fax:
Mailing address:
  • Phone: 317-850-9514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number13852
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: