Healthcare Provider Details

I. General information

NPI: 1144658998
Provider Name (Legal Business Name): STACY SNYDER L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 S GENEVA ST
ITHACA NY
14850-5417
US

IV. Provider business mailing address

329 S GENEVA ST
ITHACA NY
14850-5417
US

V. Phone/Fax

Practice location:
  • Phone: 607-277-9403
  • Fax:
Mailing address:
  • Phone: 607-277-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000605
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: