Healthcare Provider Details

I. General information

NPI: 1972079069
Provider Name (Legal Business Name): VALORIE LYNN SNYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23000 MOAKLEY ST STE 102
LEONARDTOWN MD
20650-2916
US

IV. Provider business mailing address

23000 MOAKLEY ST STE 102
LEONARDTOWN MD
20650-2916
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-5555
  • Fax: 301-475-5914
Mailing address:
  • Phone: 301-475-5555
  • Fax: 301-475-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC07303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: