Provider Demographics
NPI:1124377551
Name:SNEED, LIZZIE CORNELIA (MT)
Entity type:Individual
Prefix:
First Name:LIZZIE
Middle Name:CORNELIA
Last Name:SNEED
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MARINE DR
Mailing Address - Street 2:2B
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4228
Mailing Address - Country:US
Mailing Address - Phone:716-228-9843
Mailing Address - Fax:
Practice Address - Street 1:300 DELAWARE AVE STE 102
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202
Practice Address - Country:US
Practice Address - Phone:716-228-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025179225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist