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Individual

CHRISTINA DOMICELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1505 SHOECRAFT RD, PENFIELD, NY 14526-9707
(585) 500-5142
Mailing address
1505 SHOECRAFT RD, PENFIELD, NY 14526-9707
(585) 500-5142

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
3237931
NY

Other

Enumeration date
10/17/2015
Last updated
10/17/2015
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