Provider Demographics
NPI:1881700243
Name:SNIDMAN, ENID MARTUS (APRN,BC)
Entity type:Individual
Prefix:MRS
First Name:ENID
Middle Name:MARTUS
Last Name:SNIDMAN
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02541-0905
Mailing Address - Country:US
Mailing Address - Phone:508-548-8989
Mailing Address - Fax:508-540-7094
Practice Address - Street 1:450 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1172
Practice Address - Country:US
Practice Address - Phone:339-364-0009
Practice Address - Fax:781-784-3126
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106418364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0455Medicare ID - Type Unspecified