Healthcare Provider Details

I. General information

NPI: 1528585379
Provider Name (Legal Business Name): AMY FENIMORE SNYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD GODDARD 290
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

185 TRANSIT ST
PROVIDENCE RI
02906-1054
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-6227
  • Fax: 401-437-8344
Mailing address:
  • Phone: 617-733-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00975
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8344
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: