Provider Demographics
NPI:1770937625
Name:DOMALSKI, REBECCA S (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:DOMALSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:460 CROSS KEYS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3590
Mailing Address - Country:US
Mailing Address - Phone:585-223-6111
Mailing Address - Fax:585-223-0878
Practice Address - Street 1:460 CROSS KEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3590
Practice Address - Country:US
Practice Address - Phone:585-223-6111
Practice Address - Fax:585-223-0878
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013768208000000X
NY315740208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics