Healthcare Provider Details

I. General information

NPI: 1295199610
Provider Name (Legal Business Name): NICOLE SNYDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH ST SW BLDG SUITE402
CANTON OH
44710-1702
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 330-452-9911
  • Fax:
Mailing address:
  • Phone: 330-363-7444
  • Fax: 330-363-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.143006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: