Healthcare Provider Details

I. General information

NPI: 1033212485
Provider Name (Legal Business Name): CANDRA LYNN SNYDER ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDRA LYNN SNYDER ANP

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NORTH CENTRE AVENUE SUITE 202
ROCKVILLE CENTRE NY
11570
US

IV. Provider business mailing address

77 NORTH CENTRE AVENUE SUITE 202
ROCKVILLE CENTRE NY
11570
US

V. Phone/Fax

Practice location:
  • Phone: 516-764-7246
  • Fax: 516-678-3525
Mailing address:
  • Phone: 516-764-7246
  • Fax: 516-678-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: