Provider Demographics
NPI:1942378781
Name:SNYDER, SHAWNA EM (D AC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:EM
Last Name:SNYDER
Suffix:
Gender:F
Credentials:D AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 AQUIDNECK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7600
Mailing Address - Country:US
Mailing Address - Phone:401-297-1642
Mailing Address - Fax:
Practice Address - Street 1:170 AQUIDNECK AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7600
Practice Address - Country:US
Practice Address - Phone:401-297-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDA00325OtherRI DEPARTMENT OF HEALTH