Healthcare Provider Details

I. General information

NPI: 1417812934
Provider Name (Legal Business Name): STACIE NICOLE SNIVELY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

9281 TOURNAMENT DR
DELMAR MD
21875-2372
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-6400
  • Fax: 410-546-6400
Mailing address:
  • Phone: 443-859-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR221942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: