Provider Demographics
NPI:1073008298
Name:SNYDER, MICHELLE T (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:T
Other - Last Name:HACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:86 W UNDERWOOD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:407-649-6876
Mailing Address - Fax:407-872-0544
Practice Address - Street 1:9750 NW 33RD ST STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4000
Practice Address - Country:US
Practice Address - Phone:954-752-9220
Practice Address - Fax:954-752-1549
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics