Provider Demographics
NPI:1083664072
Name:SNYDER, STEPHANIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 THOMAS MORE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3498
Mailing Address - Country:US
Mailing Address - Phone:859-341-9588
Mailing Address - Fax:859-341-0078
Practice Address - Street 1:215 THOMAS MORE PKWY STE A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3498
Practice Address - Country:US
Practice Address - Phone:859-341-9588
Practice Address - Fax:859-341-0078
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36411207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY679302OtherMEDICARE PTAN
H09152Medicare UPIN