Provider Demographics
NPI:1477653087
Name:SNYDER, JACQUELINE CORINNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:CORINNE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-2014
Mailing Address - Country:US
Mailing Address - Phone:518-359-7000
Mailing Address - Fax:518-359-8243
Practice Address - Street 1:7 STETSON RD
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-2014
Practice Address - Country:US
Practice Address - Phone:518-359-7000
Practice Address - Fax:518-359-8243
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030789363A00000X
NY014117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant