Provider Demographics
NPI:1689344293
Name:DOMINGUEZ, SAYMI GLORIBEL
Entity Type:Individual
Prefix:
First Name:SAYMI
Middle Name:GLORIBEL
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13902-4601
Mailing Address - Country:US
Mailing Address - Phone:607-777-2000
Mailing Address - Fax:
Practice Address - Street 1:4400 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902-4601
Practice Address - Country:US
Practice Address - Phone:607-777-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program