Healthcare Provider Details

I. General information

NPI: 1982367546
Provider Name (Legal Business Name): DEVIN VALLEY SNYDER RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HEALTHCARE DR STE 204
BIDDEFORD ME
04005-9450
US

IV. Provider business mailing address

48 BEACH BLUFF TER
CAPE ELIZABETH ME
04107-2102
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-2630
  • Fax: 207-602-8468
Mailing address:
  • Phone: 631-291-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI1633
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: