Healthcare Provider Details

I. General information

NPI: 1144681685
Provider Name (Legal Business Name): MICHELE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 NORTH AVE
PENN YAN NY
14527-1052
US

IV. Provider business mailing address

2890 LAKE TO LAKE RD
STANLEY NY
14561-9715
US

V. Phone/Fax

Practice location:
  • Phone: 315-694-7676
  • Fax:
Mailing address:
  • Phone: 315-694-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number019023
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: