Most Relevant Information
Provider Data
| NPI Number: | 1003213919 |
| Provider Name: | SEAN D DOMZALSKI PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | MA057321 |
Most Important Dates
| Enumeration Date: | 11/21/2014 |
| Last Updated: | 09/21/2015 |
Provider Practice Location
150 MUNDY STREET
MAC IV BUILDING
WILKES-BARRE
PA
18702
Practice Location Phone/Fax
| Phone: | 5708240930 |
| Fax: | 5708247755 |
Provider Mailing Location
243 S PROSPECT ST
NANTICOKE
PA
186342449
Provider Mailing Phone/Fax
| Phone: | 5704175402 |
| Fax: |