Healthcare Provider Details

I. General information

NPI: 1972274611
Provider Name (Legal Business Name): BETHANY SNEAD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12311 PERRY HWY FL 3
WEXFORD PA
15090-8344
US

IV. Provider business mailing address

12311 PERRY HWY FL 3
WEXFORD PA
15090-8344
US

V. Phone/Fax

Practice location:
  • Phone: 878-332-4149
  • Fax: 878-332-4479
Mailing address:
  • Phone: 878-332-4149
  • Fax: 878-332-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062985
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: