Provider Demographics
NPI:1760251219
Name:DOMALSKI, CASEY MCNIFF (PA-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MCNIFF
Last Name:DOMALSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:ANN
Other - Last Name:MCNIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 FLEMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2633
Mailing Address - Country:US
Mailing Address - Phone:704-616-2362
Mailing Address - Fax:
Practice Address - Street 1:725 CHERRINGTON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4318
Practice Address - Country:US
Practice Address - Phone:412-262-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical