Provider Demographics
NPI:1528058104
Name:SNYDER, SARAH MAUREEN (PAC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MAUREEN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:MAUREEN
Other - Last Name:VETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-6378
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-7601
Practice Address - Street 1:6480 HARRISON AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-6378
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-354-7651
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-2027363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000306920OtherANTHEM
OHP98005OtherMEDICARE UPIN
OH415796OtherWELLCARE
OHPA027SOtherHUMANA
OH000000306920OtherANTHEM