MEDICARE: CHELLINE MATHIS SNYDER PA-C

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	363A00000X	Physician Assistant	PA9101809	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U0385W	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1205978582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELLINE MATHIS SNYDER PA-C

Provider Business Mailing Address
First Line	:	7740 BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3804
Country	:	US
Telephone Number	:	561-752-8000
Fax Number	:	561-752-8001

Provider Business Practice Location Address
First Line	:	1054 GATEWAY BLVD
Second Line	:	SUITE 110
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8301
Country	:	US
Telephone Number	:	561-738-4770
Fax Number	:	561-738-9727

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	10/21/2015

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