MEDICARE: SANDRA LYNN SNYDER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9101056	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U0777Y	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1053300723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LYNN SNYDER P.A.

Provider Business Mailing Address
First Line	:	4200 N ARMENIA AVE
Second Line	:	SUITE 1
City	:	TAMPA
State	:	FL
Zip	:	33607-6438
Country	:	US
Telephone Number	:	813-877-4811
Fax Number	:	813-872-8978

Provider Business Practice Location Address
First Line	:	4200 N ARMENIA AVE
Second Line	:	SUITE 1
City	:	TAMPA
State	:	FL
Zip	:	33607-6438
Country	:	US
Telephone Number	:	813-877-4811
Fax Number	:	813-872-8978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/10/2019

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