Provider Demographics
NPI:1942678958
Name:SNAVELY, MARK WILLIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WILLIAM
Last Name:SNAVELY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3235
Mailing Address - Country:US
Mailing Address - Phone:321-768-9914
Mailing Address - Fax:
Practice Address - Street 1:1341 MEDICAL PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3235
Practice Address - Country:US
Practice Address - Phone:321-768-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9108998363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical