Provider Demographics
NPI:1396994273
Name:SNESKO, STEPHEN ERIC (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ERIC
Last Name:SNESKO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 S. VAL VISTA DR.
Mailing Address - Street 2:BLDG 12, SUITE 167
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295
Mailing Address - Country:US
Mailing Address - Phone:480-857-0222
Mailing Address - Fax:480-857-0222
Practice Address - Street 1:2630 S. VAL VISTA DR.
Practice Address - Street 2:BLDG 12, SUITE 167
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295
Practice Address - Country:US
Practice Address - Phone:480-857-0222
Practice Address - Fax:480-857-0222
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2826208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics