Provider Demographics
NPI:1720833296
Name:SNOW, AMBER DAWN
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:SNOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BLUE BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-2261
Mailing Address - Country:US
Mailing Address - Phone:970-756-0588
Mailing Address - Fax:
Practice Address - Street 1:3209 CYPRESS GROVE DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-2503
Practice Address - Country:US
Practice Address - Phone:407-907-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician