Provider Demographics
NPI:1982826053
Name:SNEED, CAROL DENISE (ISP)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:DENISE
Last Name:SNEED
Suffix:
Gender:F
Credentials:ISP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MULBERRY CT
Mailing Address - Street 2:28
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2861
Mailing Address - Country:US
Mailing Address - Phone:513-948-0998
Mailing Address - Fax:
Practice Address - Street 1:1 MULBERRY CT
Practice Address - Street 2:28
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2861
Practice Address - Country:US
Practice Address - Phone:513-948-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2644080171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2644080Medicaid