Healthcare Provider Details

I. General information

NPI: 1275836116
Provider Name (Legal Business Name): SHELLEY GAYE SNYDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W WASHINGTON ST
SHELBYVILLE IN
46176-1236
US

IV. Provider business mailing address

150 W WASHINGTON ST
SHELBYVILLE IN
46176-1236
US

V. Phone/Fax

Practice location:
  • Phone: 317-421-5674
  • Fax: 317-398-1813
Mailing address:
  • Phone: 317-421-5674
  • Fax: 317-398-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003514A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: