Healthcare Provider Details

I. General information

NPI: 1609658244
Provider Name (Legal Business Name): NANCY SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 SOUTHWESTERN BLVD
HAMBURG NY
14075-1400
US

IV. Provider business mailing address

10615 PARTRIDGE RD
HOLLAND NY
14080-9630
US

V. Phone/Fax

Practice location:
  • Phone: 716-912-6643
  • Fax:
Mailing address:
  • Phone: 716-912-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: