Provider Demographics
NPI:1568154037
Name:SNYDER, DETRICK S (RDN)
Entity Type:Individual
Prefix:
First Name:DETRICK
Middle Name:S
Last Name:SNYDER
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-1363
Mailing Address - Country:US
Mailing Address - Phone:720-648-6701
Mailing Address - Fax:
Practice Address - Street 1:5001 VALLEJO ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-1363
Practice Address - Country:US
Practice Address - Phone:720-648-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86105803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered