Healthcare Provider Details

I. General information

NPI: 1417602772
Provider Name (Legal Business Name): AMY D SNYDER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 RUNNING DEER DR
AUBURN PA
17922-9336
US

IV. Provider business mailing address

1786 RUNNING DEER DR
AUBURN PA
17922-9336
US

V. Phone/Fax

Practice location:
  • Phone: 570-617-6604
  • Fax:
Mailing address:
  • Phone: 570-617-6604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003800
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDN003800
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: