Provider Demographics
NPI:1952331126
Name:SNYDER, STEPHANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:NELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5701 WEST 119TH STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3749
Mailing Address - Country:US
Mailing Address - Phone:913-345-8500
Mailing Address - Fax:913-345-3784
Practice Address - Street 1:5701 WEST 119TH STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3749
Practice Address - Country:US
Practice Address - Phone:913-345-8500
Practice Address - Fax:913-345-3784
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS418910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100162620AMedicaid
KS1258509OtherUNITED HEALTHCARE
GA110090666OtherRAILROAD MEDICARE
MO20996021OtherBLUE CROSS BLUE SHEILD
MO207715103Medicaid
KS897514OtherAETNA
KS2835084AMedicare PIN
B68400Medicare UPIN