Provider Demographics
NPI:1336107887
Name:SCIAMANDA, DOMINIC M (DO)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:M
Last Name:SCIAMANDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4935
Mailing Address - Country:US
Mailing Address - Phone:814-456-1097
Mailing Address - Fax:814-287-9375
Practice Address - Street 1:1920 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4935
Practice Address - Country:US
Practice Address - Phone:814-456-1097
Practice Address - Fax:814-287-9375
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOKO000013171100000X, 171100000X
PAOS013178204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP023289OtherGATEWAY
PA1013826810002Medicaid
PA001773762OtherBLUE CROSS/BLUE SHIELD
PAI42117Medicare UPIN
PA110972Medicare PIN