Provider Demographics
NPI:1407131253
Name:SNYDER, JACLYN K (R-PAC)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:K
Last Name:SNYDER
Suffix:
Gender:F
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9677 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-8738
Mailing Address - Country:US
Mailing Address - Phone:315-668-3908
Mailing Address - Fax:
Practice Address - Street 1:9677 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-8738
Practice Address - Country:US
Practice Address - Phone:315-668-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant