Healthcare Provider Details

I. General information

NPI: 1134597339
Provider Name (Legal Business Name): ANDREW SNIDER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRITTONFIELD PKWY STE A100
EAST SYRACUSE NY
13057-9227
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2866
US

V. Phone/Fax

Practice location:
  • Phone: 315-449-3800
  • Fax: 315-449-0558
Mailing address:
  • Phone: 315-449-3800
  • Fax: 315-449-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number019182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: