Healthcare Provider Details

I. General information

NPI: 1538563804
Provider Name (Legal Business Name): AMBER SNYDER CST/CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 WARREN AVE SUITE 103
WILLIAMSPORT PA
17701-2647
US

IV. Provider business mailing address

1705 WARREN AVE SUITE 103
WILLIAMSPORT PA
17701-2647
US

V. Phone/Fax

Practice location:
  • Phone: 570-320-7577
  • Fax: 570-320-7576
Mailing address:
  • Phone: 570-320-7577
  • Fax: 570-320-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number152255
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: