Healthcare Provider Details

I. General information

NPI: 1972933661
Provider Name (Legal Business Name): CHARITY AMELIA SNYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 STATE HIGHWAY 28
MILFORD NY
13807-1147
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-6542
  • Fax:
Mailing address:
  • Phone: 607-547-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA056445
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number020780
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: