Provider Demographics
NPI:1760139984
Name:SNYDER, ALEXA MARIE
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:CHATEAUGAY
Mailing Address - State:NY
Mailing Address - Zip Code:12920-0624
Mailing Address - Country:US
Mailing Address - Phone:518-524-8864
Mailing Address - Fax:
Practice Address - Street 1:15 4TH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1340
Practice Address - Country:US
Practice Address - Phone:518-483-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY823304163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)