Individual
ANGELINA M DOMENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
953 DANBY RD, ITHACA, NY 14850-7002
(607) 274-3011
Mailing address
138 LINCOLN AVE, WADDINGTON, NY 13694-3100
(315) 388-4299
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
NY
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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