Healthcare Provider Details

I. General information

NPI: 1093815383
Provider Name (Legal Business Name): SANDRA M SNYDER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 LORAIN AVE
CLEVELAND OH
44111-5605
US

IV. Provider business mailing address

6000 W CREEK RD SUITE 10
INDEPENDENCE OH
44131-2139
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-7088
  • Fax: 216-476-7604
Mailing address:
  • Phone: 800-223-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34007610
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: