Provider Demographics
NPI:1013793603
Name:SNIPE, BRYAN THOMAS (NP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:THOMAS
Last Name:SNIPE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6738C 190TH LN APT 2A
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3733
Mailing Address - Country:US
Mailing Address - Phone:347-776-1617
Mailing Address - Fax:
Practice Address - Street 1:16040 78TH RD
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1969
Practice Address - Country:US
Practice Address - Phone:347-776-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF432580-01363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care