Provider Demographics
NPI:1043216161
Name:SNYDER, MICHELLE LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 N 2ND ST
Mailing Address - Street 2:STE 102
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1353
Mailing Address - Country:US
Mailing Address - Phone:727-531-1050
Mailing Address - Fax:727-531-1208
Practice Address - Street 1:328 N 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1353
Practice Address - Country:US
Practice Address - Phone:812-910-0544
Practice Address - Fax:812-494-2600
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2019-02-24
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
IN02001984A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02001984AOtherSTATE LICENSE