Provider Demographics
NPI:1093194631
Name:DOMANOWSKI, SYDNEY (DO)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:
Last Name:DOMANOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 LIBERTY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-1626
Mailing Address - Country:US
Mailing Address - Phone:585-496-5007
Mailing Address - Fax:
Practice Address - Street 1:408 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1015
Practice Address - Country:US
Practice Address - Phone:585-786-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299071-1207Q00000X
PAOT016524207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program