| Doctor Name: | SEAN D DOMZALSKI |
| NPI Number: | 1003213919 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | MA057321 |
| Business Practice Address: | 150 Mundy Street Mac Iv Building Wilkes-barre, PA - 18702 |
| Business Phone Number: | 5708240930 |
| Business Fax Number: | 5708247755 |
| Mailing Address: | 243 S Prospect St, NANTICOKE |
| State: | PA |
| Postal Code: | 186342449 |
| Phone Number: | 5704175402 |
| Fax Number: | |
| NPI Enumeration Date: | 11/21/2014 |
| NPI Last Update Date: | 09/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA057321 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |