Healthcare Provider Details

I. General information

NPI: 1780246983
Provider Name (Legal Business Name): DANYELLE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 KETTERING BLVD
MORAINE OH
45439-1983
US

IV. Provider business mailing address

72 CATHERINE CT
GERMANTOWN OH
45327-9304
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8300
  • Fax:
Mailing address:
  • Phone: 937-751-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: