Provider Demographics
NPI:1881034296
Name:DOMROES, JACLYN M (PA)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:DOMROES
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Gender:F
Credentials:PA
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Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:3900 N BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1842
Practice Address - Country:US
Practice Address - Phone:716-656-4456
Practice Address - Fax:716-817-1785
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2021-12-10
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Provider Licenses
StateLicense IDTaxonomies
NY016580363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant