Healthcare Provider Details

I. General information

NPI: 1720407380
Provider Name (Legal Business Name): SHANNON SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 4TH ST
TROY NY
12180-5324
US

IV. Provider business mailing address

435 4TH ST
TROY NY
12180-5324
US

V. Phone/Fax

Practice location:
  • Phone: 518-271-6777
  • Fax:
Mailing address:
  • Phone: 518-271-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: