Provider Demographics
NPI:1770136137
Name:MACKROY-SNELL, EDWINA PATRICE (MED)
Entity type:Individual
Prefix:
First Name:EDWINA
Middle Name:PATRICE
Last Name:MACKROY-SNELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-3503
Mailing Address - Country:US
Mailing Address - Phone:407-212-5501
Mailing Address - Fax:
Practice Address - Street 1:204 E ST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3503
Practice Address - Country:US
Practice Address - Phone:407-212-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist