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General NPI Number Information
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NPI Number | 1336687201
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Entity Type | Organization
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Legal Business Name | SNP DIRECT PATHS LLC
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 206 KRESGE FARM RD BOX 102
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City | EFFORT
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State | PA
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Zip | 18330-8137
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Country | US
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Telephone | 954-249-8694
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Fax | 570-805-2218
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Provider Business Mailing Address
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Address Line | 206 KRESGE FARM RD BOX102
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City | EFFORT
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State | PA
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Zip | 18330-8137
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Country | US
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Telephone | 954-249-8694
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Fax | 570-805-2218
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Authorized Official
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Title or Position | PHYSICIAN OWNER/PRESIDENT
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Name | DR. SANDRA PASCAL
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Credential | DO
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Telephone | 954-249-8694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS-015101
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License Number State | PA
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