Provider Demographics
NPI:1639643927
Name:SNYDER, ALEXIS MICHELLE (LAC, DOM)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:MICHELLE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19642 E COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2599
Mailing Address - Country:US
Mailing Address - Phone:786-562-9087
Mailing Address - Fax:
Practice Address - Street 1:708 6TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6418
Practice Address - Country:US
Practice Address - Phone:786-562-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3981171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist