Domenique B Canino, MS.ED
Individual provider Active NPI Specialist · Highland, NY
NPI 1295086759 · NPPES record last updated Jun 5, 2013
Key facts
- NPI
- 1295086759
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 53 Main St
Highland, NY 12528-1407 - Phone
- (914) 474-4052
- NPI assigned
- Sep 25, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008676-1 | NY | MD | Medical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes | ||
| Speech-Language Pathologist | 235Z00000X | 008676-1 | NY |
Addresses
Primary practice location
53 Main St
Highland, NY 12528-1407
Mailing address
53 Main St
Highland, NY 12528-1407
Phone (914) 474-4052
Other providers in Highland, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.