Provider Demographics
NPI:1427541317
Name:SNEDECOR, KELSEY LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEIGH
Last Name:SNEDECOR
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 1:601 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4341
Mailing Address - Country:US
Mailing Address - Phone:803-788-4886
Mailing Address - Fax:803-434-6979
Practice Address - Street 1:121 BLYTHEWOOD RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8426
Practice Address - Country:US
Practice Address - Phone:803-788-6360
Practice Address - Fax:803-788-6668
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD52675208000000X
SCLL52675208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics