Healthcare Provider Details

I. General information

NPI: 1134131535
Provider Name (Legal Business Name): RANDALL J SNYDER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 REFLECTIONS DR SUITE 110
DUBLIN OH
43017-2355
US

IV. Provider business mailing address

4143 NOTTINGHILL GATE RD
COLUMBUS OH
43220-3942
US

V. Phone/Fax

Practice location:
  • Phone: 614-792-1108
  • Fax: 614-792-0018
Mailing address:
  • Phone: 614-459-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5815
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: