| Doctor Name: | LISA DOMAGALA |
| NPI Number: | 1083726251 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RPA-C |
| License Number: | 008065-1 |
| Business Practice Address: | 500 Sterling Dr Orchard Park, NY - 141271573 |
| Business Phone Number: | 7166772273 |
| Business Fax Number: | 7166772256 |
| Mailing Address: | 500 Sterling Dr, ORCHARD PARK |
| State: | NY |
| Postal Code: | 141271573 |
| Phone Number: | 7166772273 |
| Fax Number: | 7166772256 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 08/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 008065-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |