Provider Demographics
NPI:1306317532
Name:SCHNEIDER, KENDALL LEIGH
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:LEIGH
Last Name:SCHNEIDER
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 1:43674 MAVERICK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3666
Mailing Address - Country:US
Mailing Address - Phone:703-772-1279
Mailing Address - Fax:
Practice Address - Street 1:43674 MAVERICK LN
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-3666
Practice Address - Country:US
Practice Address - Phone:703-772-1279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110006695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant