Provider Demographics
NPI:1538165253
Name:SNYDER, SHARON L (PAC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PAC
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 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-226-2663
Mailing Address - Fax:605-226-0095
Practice Address - Street 1:701 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1803
Practice Address - Country:US
Practice Address - Phone:605-226-2663
Practice Address - Fax:605-226-0095
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00267647Medicare PIN
R02564Medicare UPIN
SD100324Medicare PIN
1108470001Medicare NSC
ND712390Medicare PIN