Provider Demographics
NPI:1942419312
Name:SNEAD, TANYA SHAREE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SHAREE
Last Name:SNEAD
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 1:57 HEATHERBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9266
Mailing Address - Country:US
Mailing Address - Phone:989-714-3326
Mailing Address - Fax:
Practice Address - Street 1:57 HEATHERBRIDGE LN
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9266
Practice Address - Country:US
Practice Address - Phone:989-714-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2664933Medicaid