Healthcare Provider Details

I. General information

NPI: 1952331126
Provider Name (Legal Business Name): STEPHANIE SNYDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE NELLIS MD

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 WEST 119TH STREET SUITE 240
OVERLAND PARK KS
66209-3749
US

IV. Provider business mailing address

5701 WEST 119TH STREET SUITE 240
OVERLAND PARK KS
66209-3749
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-8500
  • Fax: 913-345-3784
Mailing address:
  • Phone: 913-345-8500
  • Fax: 913-345-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number418910
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: