Healthcare Provider Details

I. General information

NPI: 1215420112
Provider Name (Legal Business Name): AMANDA ELIZABETH SNYDER CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 4TH AVE
BROOKLYN NY
11220-5350
US

IV. Provider business mailing address

19 TEMPLE CT
BROOKLYN NY
11218-1211
US

V. Phone/Fax

Practice location:
  • Phone: 484-252-1986
  • Fax:
Mailing address:
  • Phone: 484-252-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95008642
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: