Healthcare Provider Details

I. General information

NPI: 1659082766
Provider Name (Legal Business Name): KATIE LEE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PARKER AVE
MASSENA NY
13662-2215
US

IV. Provider business mailing address

40 PARKER AVE
MASSENA NY
13662-2215
US

V. Phone/Fax

Practice location:
  • Phone: 315-408-1222
  • Fax:
Mailing address:
  • Phone: 315-408-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: