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NPI Code Detail

MEDICARE: DR. SHANNA DOMOND

MEDICARE: DR. SHANNA DOMOND
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist

General Provider Information

NPI Number : 1588266076
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNA DOMOND
Provider Business Mailing Address
First Line : 68 S SERVICE RD STE 100
Second Line :
City : MELVILLE
State : NY
Zip : 11747-2350
Country : US
Telephone Number : 347-231-6482
Fax Number :
Provider Business Practice Location Address
First Line : 68 S SERVICE RD STE 100
Second Line :
City : MELVILLE
State : NY
Zip : 11747-2350
Country : US
Telephone Number : 516-749-9047
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2020
Last Update Date : 04/21/2024

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Directions to “ DR. SHANNA DOMOND ” Practice Location

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