Individual
SARAH ANNE DOMENICUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA, ATC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50002344
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000475889
ANTHEM PIN
OH
Enumeration date
01/12/2006
Last updated
01/25/2022
Update your record
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