Provider Demographics
NPI:1699024877
Name:CHIAPPETTA, DOMINIC JAMES (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:JAMES
Last Name:CHIAPPETTA
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 947381
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7381
Mailing Address - Country:US
Mailing Address - Phone:386-231-3540
Mailing Address - Fax:386-231-3544
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 505
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5170
Practice Address - Country:US
Practice Address - Phone:386-231-3540
Practice Address - Fax:386-231-3544
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001645-1171100000X
NY005811363AS0400X
FLPA 9108080363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No171100000XOther Service ProvidersAcupuncturist