Provider Demographics
NPI:1750767190
Name:SNIDER, JAYLA
Entity type:Individual
Prefix:MRS
First Name:JAYLA
Middle Name:
Last Name:SNIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAYLA
Other - Middle Name:
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-0921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 VISTA PL
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935
Practice Address - Country:US
Practice Address - Phone:631-513-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist