Provider Demographics
NPI:1083726251
Name:DOMAGALA, LISA (RPA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DOMAGALA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MULHISEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:500 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1573
Mailing Address - Country:US
Mailing Address - Phone:716-677-2273
Mailing Address - Fax:716-677-2256
Practice Address - Street 1:500 STERLING DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1573
Practice Address - Country:US
Practice Address - Phone:716-677-2273
Practice Address - Fax:716-677-2256
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008065-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical