Healthcare Provider Details

I. General information

NPI: 1487000311
Provider Name (Legal Business Name): MOLLY SNYDER RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 MCARTHUR RD
JAMESTOWN PA
16134-4925
US

IV. Provider business mailing address

1903 MCARTHUR RD
JAMESTOWN PA
16134-4925
US

V. Phone/Fax

Practice location:
  • Phone: 814-282-4218
  • Fax:
Mailing address:
  • Phone: 814-282-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005756
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: