Healthcare Provider Details

I. General information

NPI: 1447524137
Provider Name (Legal Business Name): JEFFREY DOUGLAS SNEDAKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 UNIVERSITY PARK BLVD
LAYTON UT
84041-1611
US

IV. Provider business mailing address

PO BOX 95970
SOUTH JORDAN UT
84095-0970
US

V. Phone/Fax

Practice location:
  • Phone: 801-779-6200
  • Fax:
Mailing address:
  • Phone: 801-352-9500
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8183475-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: