Healthcare Provider Details

I. General information

NPI: 1861012064
Provider Name (Legal Business Name): JORDAN S SNIDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 OMNI BLVD STE 114
NEWPORT NEWS VA
23606-4430
US

IV. Provider business mailing address

860 OMNI BLVD STE 401
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-232-8856
  • Fax: 757-232-8857
Mailing address:
  • Phone: 757-232-8860
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007336
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: