Healthcare Provider Details

I. General information

NPI: 1902901929
Provider Name (Legal Business Name): MELINDA SUSAN SNYDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 WESTBROOK DR
BUTNER NC
27509-1633
US

IV. Provider business mailing address

158 WESTBROOK DR
BUTNER NC
27509-1633
US

V. Phone/Fax

Practice location:
  • Phone: 919-575-6686
  • Fax: 919-575-7418
Mailing address:
  • Phone: 919-575-6686
  • Fax: 919-575-7418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNC24099
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: