Provider Demographics
NPI:1891925145
Name:SNELL, AMANDA MALVICA (AUD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MALVICA
Last Name:SNELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 COLONIAL DR STE 3
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8603
Mailing Address - Country:US
Mailing Address - Phone:607-795-6225
Mailing Address - Fax:607-329-1422
Practice Address - Street 1:63 COLONIAL DR STE 3
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8603
Practice Address - Country:US
Practice Address - Phone:607-795-6225
Practice Address - Fax:607-329-1422
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006117231H00000X
NY002275231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist