Provider Demographics
NPI:1609171545
Name:DOMMELL, DANIEL JAMES
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:DOMMELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4536 MAIN ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3828
Mailing Address - Country:US
Mailing Address - Phone:716-245-5144
Mailing Address - Fax:
Practice Address - Street 1:4536 MAIN ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3828
Practice Address - Country:US
Practice Address - Phone:716-245-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist