Provider Demographics
NPI:1679221592
Name:SNAVELY, STEFANY (LPN)
Entity Type:Individual
Prefix:
First Name:STEFANY
Middle Name:
Last Name:SNAVELY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 CLAREMONT TERRACE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5950
Mailing Address - Country:US
Mailing Address - Phone:315-269-7083
Mailing Address - Fax:
Practice Address - Street 1:919 SYMONDS PL
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5621
Practice Address - Country:US
Practice Address - Phone:315-272-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325434-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0521Medicaid