MEDICARE: SALLY VAN SNEPSON PA

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	171100000X	Acupuncturist	AC 287	ME
2	363A00000X	Physician Assistant	PA-817	ME
3	363A00000X	Physician Assistant	5181	AZ

General Provider Information

NPI Number	:	1467428912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY VAN SNEPSON PA

Provider Business Mailing Address
First Line	:	1847 W HEATHERBRAE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-4764
Country	:	US
Telephone Number	:	602-274-2100
Fax Number	:	602-535-3166

Provider Business Practice Location Address
First Line	:	1847 W HEATHERBRAE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-4764
Country	:	US
Telephone Number	:	602-274-2100
Fax Number	:	602-535-3166

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	05/01/2025

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Directions to “ SALLY VAN SNEPSON PA” Practice Location

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