Provider Demographics
NPI:1396825899
Name:ZUCCARO, DOMENICA (AA)
Entity Type:Individual
Prefix:
First Name:DOMENICA
Middle Name:
Last Name:ZUCCARO
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:DOMENICA
Other - Middle Name:
Other - Last Name:RANDAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2358
Mailing Address - Country:US
Mailing Address - Phone:216-674-5230
Mailing Address - Fax:216-674-5231
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:216-674-5230
Practice Address - Fax:216-674-5231
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000121367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2696739Medicaid
OHRA4194871Medicare PIN