Healthcare Provider Details

I. General information

NPI: 1952691172
Provider Name (Legal Business Name): KENNETH SHON SNELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105-0401
US

IV. Provider business mailing address

1305 W 18TH ST PO BOX 5039
SIOUX FALLS SD
57105-0401
US

V. Phone/Fax

Practice location:
  • Phone: 605-333-1730
  • Fax: 605-333-1966
Mailing address:
  • Phone: 605-333-1730
  • Fax: 605-333-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number1223
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: