Provider Demographics
NPI:1518459353
Name:DOMOND, DOLORES JOANA I (NA)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:JOANA
Last Name:DOMOND
Suffix:I
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1334
Mailing Address - Country:US
Mailing Address - Phone:718-819-8623
Mailing Address - Fax:347-836-8305
Practice Address - Street 1:3612 36TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1334
Practice Address - Country:US
Practice Address - Phone:718-819-8623
Practice Address - Fax:347-836-8305
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator